I am so stressed, didnt go well at the urologist today. need advice

[NYMOM07]

so my son had an infection in his foreskin about 2 weeks ago, a pretty bad one, his entire penis swelled, extreme pain, hard to urinate, until the antibiotics kicked in in about 24 hours.  so we had the followup today, they checked his bladder and kidneys with a sonogram, said everything was good there, and that what he had was not a uti but balantis.  he prescribed betamethasone dipropionate, to be put on the foreskin 3 times a day for 3 weeks, with gentle pulling back on the foreskin about 5 times a day. he said that 85% of the time the foreskin will retract after this treatment, but that with my son he didnt think it as likely because by looking and examing his foreskin (gently) he said that there may be scar tissue ? under the foreskin and that the hole of the foreskin is more like a line not a circle indicating some kind of tearing? not sure what caused that.

he said that if his foreskin did not retract at the end of the 3 weeks with the betamethasone, he recommends a circumcision.

what would you ladies do? he said that the infection was caused because the dead skin cells on the head of the penis could not be cleaned because his foreskin will not retract, therefore, this kind of infection will happen again.  i dont if it matters but he is the head of pediatric urology at the local childrens hospital here on long island so i know that he is more than qualified to make this diagnosis, but i am just not sure if i am jumping the gun. on the other hand, the infection was very severe, and i would not want my son to go through that again.

thanks

[tammylsmith]

What would you do if you had a daughter with extreme welling and redness on her labia? Would surgery even be an option? I know there are others far more medically knowledgeable than me... but that advice seems fishy. Dead skin cells i.e. smegma are normal. Urologists get paid more when you opt for surgery... so what would be the motivation to tell you to leave it alone? Also, how old is your son? I think avg age for retractability is 10 years. Retraction, even gently is a no no.

[tammylsmith]

Sorry, but I was interrupted mid thought by ds. No doctor should b retracting at all is what I was trying to say. You shouldn't be either, no matter how gently because you could irritate it (making it red, which the doc then thinks is proof circ is needed... a vicious cycle) Just your son. I once had a UTI that was incredibly painful for me... but antibiotics did the trick. Your son responded to antibiotics, so why does doc still think more needs to be done?

Google health said this:

 

"Most cases of balanitis can be controlled with medicated creams and good hygiene. Surgery is not usually necessary. Outcomes are nearly always positive."   ---It seem like the Urologist is just pro circ in the first place.

Your son is little, I'd bet, and circumcision is a really extreme option. Def. get a second opinion!

[NYMOM07]

my son is 3 years 4 months. yes, its dr. palmer who is at cohens childrens hospital. i know that surgery seems extreme- i didnt circ him then and i dont want to do it now. the thing is, how do you know that a child doesnt have a legitimate problem with their foreskin- prone to infections, not able to retract- he told me that most kids by this age can retract, a complete contradiction to what i see on this site.  is the cream a totally bad idea or is it worth trying?  i am going to have the consult results sent to my pedi, i guess i will see what she says too

[tammylsmith]

Only 3? Way to young to be worried about retraction! If you are worried about ds being in pain, just remember circ won't necessarily fix that. My good friend's son (4years old) had a botched circ and has been in constant pain for 3 years, and will need a redo. If it were me, I would stop the cream. Get another opinion. A common recommendation on this board is to have him pee in a cup of warm water if peeing hurts. If he is doing fine now, just leave it alone! Penises (peni? lol, sorry but rarely do I use the term in plural) are made by nature to swell, so I think it doesn't take much to look like a huge problem.  Balanitis seems to be diagnosed just from a red, irritated penis, but it seems like other things cause that too... When all you've got is a hammer, everything looks like a nail... When the only tool in your arsenal is circumcision... it seems that everything starts to look like a reason to use it.

and sorry to go on and on, but it doesn't matter if he/she were president of the American Society of urologists (my made up group...) if bias exists, and is supported by financial incentive, the you will not get an objective opinion. Maybe go see a different pediatrician? Specialists will just be looking for problems.

[Super~Single~Mama]

Originally Posted by NYMOM07 

my son is 3 years 4 months. yes, its dr. palmer who is at cohens childrens hospital. i know that surgery seems extreme- i didnt circ him then and i dont want to do it now. the thing is, how do you know that a child doesnt have a legitimate problem with their foreskin- prone to infections, not able to retract- he told me that most kids by this age can retract, a complete contradiction to what i see on this site.  is the cream a totally bad idea or is it worth trying?  i am going to have the consult results sent to my pedi, i guess i will see what she says too

Maybe "most" kids are retractable by this age, but your ds is not.  Thats normal, maybe its not "average" - but your ds is an individual.  Have you checked the dr's opposing crc website?  I found a list of foreskin friendly dr's, and the closest one to you (on that list) is in Mt. Vernon, NY - but its quite a drive.  Is your ped foreskin friendly? 

I know you don't want your ds to go through that again - but I can only imagine circ, when he's not retractable yet, would be SO much worse!  And, since its happened once, will you recognize the signs and be able to treat it sooner?

It really doesn't sound like it was due to dead skin cells - thats called smegma and both males and females have it, and its totally normal.  It sounds like the ped urologist wants him to be retractable so that you can clean under the foreskin - but the penis is pretty self cleaning, and doesn't require "cleaning" so much as  a little rinsing here and there.

[Super~Single~Mama]

oops, double post.

[Storm Bride]

Originally Posted by NYMOM07 

the thing is, how do you know that a child doesnt have a legitimate problem with their foreskin- prone to infections, not able to retract- he told me that most kids by this age can retract, a complete contradiction to what i see on this site.

Is your son prone to infections? Has he had many (and were they confirmed to be infections through taking cultures)? Not being able to retract isn't an issue. How would the urologist know how old most boys are when they are first able to retract if he cuts off the foreskins of all the "abnormal" ones who can't??? My youngest was somewhere around your son's age - can't remember exactly - when he first retracted...and proudly showed us his new "cool trick"...but my oldest stopped being naked around the house at age eight, when his stepdad moved in, and he wasn't retracting yet. He's just fine.

I suppose a child could have a legitimate problem with his foreskin...but the question here is more "what reason is there to think there is a problem?", not "how do you know there isn't one?".

[Lauren82]

My son can only retract 3/4ths of the way at 8 years old. When we had the talk about genital hygiene, he rolled his eyes at me and said he knows when to rinse it "down there". So what that tells me is that it probably gets washed once a year. At 3 years old he still had a pin size opening for pee to come through and that's it. Nothing was ever cleaned on the inside because it doesn't need to be.

I'm not on my PC with all of my bookmarks, but there are several sources that claim it's normal for some boys to not retract fully even up until puberty. There is not a certain age by which it magically retracts.

Did the doctor do a swab to determine the type of infection? I have heard of some boys having alarming redness and entire penis swelling from the normal separation process. I would certainly consider everything else before circumcision if it were my son. Is the the only time it has happened? You putting steroid cream on it and trying to forcefully retract is going to make things worse so please don't do that.

Perhaps you could e-mail one of the doctors at Doctors Opposing Circumcision and see what they say. http://www.doctorsopposingcircumcision.org/about/contact.html

[MCatLvrMom2A&X]

I figured this is what the urologist would tell you when you posted those weeks ago and I believe I posted pretty much how the visit would go from him saying he should be retractable to the cream but it might have been another thread.

I do not agree with anything he told you because it dosnt hold up to the current research showing 10.5 yo is the avg age for retraction. Also the hole should be small that is how stuff stays out.

One infection that cleared up with abx is not cause for circ. that is why my brother was circed at 3yo because my mom just went with what the Dr. said she didnt have any other source of information. There is no way I would circ over infection for my ds or dd that is what abx are for.

Like pp's said this Dr. gets paid to cut foreskins off not save them. You should contact Marylin Milos and find a foreskin knowledgeable Dr where you are. She will be more than happy to help you and your ds out.

I would not use the cream because of the steroid and also because once you stop it his foreskin will go back to its natural state which is being non retractable right now. Dead skin cells do not cause infection. I dont know where the Dr. came up with that one.

Did the Dr. even mention the dorsel slit to allow your ds to retract or even just removing the tip of the foreskin to allow it to? If he didnt then he didnt give you all the information you needed. A full circ would be the very last thing to try not the first or even second option. Like almost all american Dr. they see a foreskin and they see circ.

Please call the number I am begging you for your ds's sake. I know what happened scared you badly but mama think about this if this was your dd the Dr wouldnt be telling you to cut things off her genitals he would have told you to treat with abx just like they did with your ds.
NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
[e-mail]
Phone: [phone]
Fax: [phone]
www.nocirc.org

OK here is my thinking if you leave him intact what is the worst thing that can happen? Another infection at that time you can revisit the option to have him circed. Worst case if you go through with having him circed. He will have to go under GA and with GA there is always a risk of death rare yes but the risk is there. The Dr could remove to much skin and leave him with lifelong problems. He could end up with meatel stenosis and having to have treatment for that which is very painful. He could be fine. To me the least damaging option is to keep him intact the only risk there is more infection the risks of circ are to many for me to name. Yes I am totally 100% against circ of a child and my views are one sided but they are valid.

The only one who will know for sure if your ds really and truly is one of the rare ones who has a issue with his foreskin is to find a Dr. who is intact knowledgable the only way to do that is to contact nocirc or milos and have them tell you who to go to. I am sure being in NY that there will be one very near you and your ds deserves to have the best Dr. available with the most knowledge.
Edited by MCatLvrMom2A&X - 12/1/10 at 6:57pm

[tammylsmith]

I have been checking back in on you because I've been thinking a lot lately about some pro circ stuff my pediatrician said to me that got me thinking about the whole bias issue. I know it's hard to see things that go so far against what an "expert" recommended. It probably causes a lot of conflict, because I know it did for me when I was first researching my decision. We've had no trouble at all, but I watch the "trouble" posts a lot to make sure I'm ready for anything, and it almost always ends up being something so minor and easily taken care of... and I know you know that circ is such major surgery! I really hope you feel better about the info , and I agree with the above that you should get another opinion from a foreskin friendly doc (probably not a urologist!)

[NYMOM07]

Thank you so much everyone for your help! i really appreciate it, i am going to call those numbers Mcatlvrmom2a&x, and find a more intact friendly urologist. i am going to stop the cream and talk to my pedi, she is pretty intact friendly and i want to see what she has to say.

he is not prone to infection, but he did have walking pneumonia this october, and was on 2 antibiotics for that, this has been a rough season with starting nursery school and colds, being exposed to a lot of different things, and i am more leaning towards that being a cause of what happened, or a freak one time thing that wont necesarily happen again.  i dont want to circ him, and i wont, i think it is unnecessary but it is so hard with these doctors that are so pushy, and convincing while you are in their office.  i will let you all know what happens with a second opinion, or i will just leave him alone if i cant find a good doctor to see him for another opinion. thanks again! muah

[MCatLvrMom2A&X]

I am sure that Marylin Milos can help you out. I know she has several others from here in the past.

[littlemizflava]

i wanted to peep up and say my ds is 4y1m he can NOT be retracted at all. some boys even to early 20's just have very tight sphincter. i would not do the cream. i would just leave it alone. wash him with uncolored unscented glycerin  soap soap while standing up in the tub rince him then fill the tub with clean water and let him play in it every night. maybe put him in boxers if he is in underwear. 

[Cheshire]

My son has had both a yeast infection when he was about 2 years old (from a summer spent in wet swim diapers) which cleared up quickly once we started treating it.  But, it did take a little longer than the 7 day treatment, more like 10 days. 

Then, when he was around 4 he developed recurrent UTIs.  I searched high and low for an intact friendly urologist.  Our ped treated the UTI a few of times but after yet another round of antibiotics and a fourth culture came back showing the infection she sent us to her regular urologist.  I was scared to take him so I first went to our family doc.  He was surprised he was intact and immediately suggested circ.  I told him "that's not an option."  He looked at me like I had two heads and then hemmed and hawed around "well, I don't know your reasons but, blah, blah, blah."  So, I contacted Docs Opposing and they didn't know of anyone in our area.  I talked to Marilyn and she was supportive but didn't know anyone in our area either.  I heard of one in a town close to us but when I called they said he wouldn't see our son unless he had had a kidney reflux test (can't remember the name but it included inserting a cath, filling the bladder with dye, etc.).  I wasn't going to put my son through the test until I had actually talked to someone. So, I made the appt with the urologist our ped suggested.  It actually wasn't as bad as I had expected.  I posted on here about the issues and someone suggested a certain antibiotic for the e-coli bacteria found in the cultures.  The doc and I talked about it and he agreed trying a longer course of this antibiotic would be worth a shot.  He didn't jump right to circ but he did say that one of the reasons they circ in Europe was for recurrent UTIs.  Not sure why he brought up Europe and some of the other info he shared sounded weird to me so I took it with a grain of salt.  He did say one thing that I agreed with - he said if you circ and it doesn't clear up the infections it's not like you can put the foreskin back on.  Um, yes sir!  So, I used the same line that "circ isn't an option" and he at least didn't look at me like I was an alien.

He did manipulate my son's foreskin a little but was not alarmed that he wasn't fully retractable and he didn't force it.  He didn't ask anything about cleaning it or retraction.  He just took a quick glance.

So, during this new treatment of antibiotics we figured out that our son, who was learning to wipe his own bottom, would wipe and then dab the tip of his penis with the paper.  He was reinfecting himself.  We explained what was happening when he did that and he stopped and the infection hasn't come back.  Who knew you'd have to have a similar talk with our boys as with our girls (the "wipe from front to back" talk). 

All of that background to say I know how hard it can be to stand up to the pressure from docs.  I would totally agree with seeking another opinion.  And, even if you can't find an intact friendly doc you know that the infection has cleared up.  I would take the wait and see approach.  If the infection comes back it can be treated.  There are plenty of comfort measures to use until antibiotics kick in.  I remember with our son's yeast infection the swelling was such a surprise and he was very uncomfortable when he would pee.  It can be alarming but warm baths helped a lot.

Stick to your guns and go with your gut instinct that he is fine and will be fine.  I'd stop the cream, too.  I'd leave well enough alone.  If he develops another infection I'd get a culture to figure out what bacteria is causing it and then treat it.  I would go with the odds that he won't get another one.  And, even if he does, you can treat the new infection and go back to wait and see again.  After months of the whole UTI drama and driving ourselves nuts with worry about what was causing it, and plenty of worry about what the docs would suggest to "fix" it we took it one day at a time.  Now two years later our son is still whole and infection free.  All of the hassle was worth it. 

Best wishes!

[eepster]

I haven't read all the replies,so forgive me if I'm repeating...

There is nothing wrong with your DS, he needs no further treatment is necessary.

The antibiotics cleared up the possible infection (was that ever confirmed by a culture.)  It is over and done.  If he ever has another, you can get antibiotics again.

Steroid treatments are for adults.  It is developmentally normal for boy to be unable to retract before puberty.

The steroid treatment will not make your DS retractable in 3 weeks.  That is not b/c he needs to be circ'd, it is b/c the cream only works when combined with stretching exercises that are inappropriate for children (they a basically focused masturbation.)

[MyBoysBlue]

I just wanted to relate my experience with my sons, what I call a round of swelling.  He was 3 years old at the time and he swelled right up and had some greeny yellowy discharge.  After three days of just watching that it didn't get any worse it started to get better all on its own.  After he was all healed up I noticed he was now ballooning or at least I was able to see the path the pee took to exit the foreskin.  Now at 4 he still isn't retractable.  My older son was by this age.  But thanks to the info gathered here I know that this is perfectly normal.  Personally I think it would be wise to just leave things alone.  He sounds link he is fine now.

[eepster]

Originally Posted by NYMOM07 

Thank you so much everyone for your help! i really appreciate it, i am going to call those numbers Mcatlvrmom2a&x, and find a more intact friendly urologist. i am going to stop the cream and talk to my pedi, she is pretty intact friendly and i want to see what she has to say.

he is not prone to infection, but he did have walking pneumonia this october, and was on 2 antibiotics for that, this has been a rough season with starting nursery school and colds, being exposed to a lot of different things, and i am more leaning towards that being a cause of what happened, or a freak one time thing that wont necesarily happen again.  i dont want to circ him, and i wont, i think it is unnecessary but it is so hard with these doctors that are so pushy, and convincing while you are in their office.  i will let you all know what happens with a second opinion, or i will just leave him alone if i cant find a good doctor to see him for another opinion. thanks again! muah

I read through this time

Taking so many antibiotics can lead to a yeast infection.  If he is still getting an symptoms, you can use an OTC yeast treatment, such as monistat.

[smeep]

Originally Posted by NYMOM07 

my son is 3 years 4 months. yes, its dr. palmer who is at cohens childrens hospital. i know that surgery seems extreme- i didnt circ him then and i dont want to do it now. the thing is, how do you know that a child doesnt have a legitimate problem with their foreskin- prone to infections, not able to retract- he told me that most kids by this age can retract, a complete contradiction to what i see on this site.  is the cream a totally bad idea or is it worth trying?  i am going to have the consult results sent to my pedi, i guess i will see what she says too

Forgive me, but he's only had ONE infection, correct? I hardly consider that being prone to infection. Even if he was prone to infection, there are better ways to deal with it. The two most important places to look, IMO, are diet and hygiene.

Many, many children at your son's age are not retractable and that's perfectly normal! It's completely normal for them to not even start retracting until puberty! My son is 5 and, as far as I know, he doesn't retract (I've asked him and told him how to clean it when it does and it doesn't sound like it's retractable). I'm not worried one bit.

The cream is a bad, bad idea. But I'm sure others have said that.

[buckeyedoc]

6-year-old DS is not at all retractable, and the pediatrician said it was normal not to happen until puberty (I know that, so I didn't ask, but DH asked about it because he must not believe me).

I would do the medical treatment but not the circumcision. I think that is a very extreme recommendation. I guess when all you have is a hammer (you are a surgeon), everything looks like a nail.