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Redundant prepuce, phimosis and phimotic band

post #1 of 6
Thread Starter 

My little 4 ½  y.old nephew has been diagnosed with the above by child urologists,

My SIL  is very against circumcision (I am as well) and insisted on trying treating it with steroid cream first.  To me that diagnosis sound like a BS diagnosis since non-retractable and long foreskin is normal for children, at least all articles say to leave it alone unless there is a problem. I think that she needs to take him for second opinion to a doctor who is foreskin friendly, but I als do not want to rile her up aganst the advise of her doctor because there might actually be an issue.

In last two years, he had couple episodes with friequent urges, pain while peeing  and ballooning. Last one started a week ago. Regular ped ruled out UTI and agreed with SIl that friequent urges might be caused by bladder spasms, it was also suggested to her that pain might be caused by irritation by urine due to ballooning and that there might be skin infection on foreskin that causes pain. 

Now to tis morning. She wrote that  LO is having a hard time peeing, only drops come out at the one time , urologist gave them diagnosis of “Redundant Prepuce and Phimosis” and that he has a rock hard “phimotic band” that blocks urine flow. She did not give any update on his urges or pain.

How fast can scar tissue build up to cause such issues if he had normal flow of urine two weeks ago?

post #2 of 6
Thread Starter 

So, 27 views and no replies? Anybody? 

post #3 of 6
At 4yo a diagnosis of phimosis is not possible since he should have it meaning that if he is not retractable he shouldnt be. Unless someone has been trying to retract him all his life he should not have have scar tissue The thing about the tip of the foreskin it is a sphincter just like the anus and if you try to force it open you will get major resistance unless it is in use while urinating it should clamp pretty tight. A Dr. trying to force it will cause it to react by clamping.

When the Dr. told me ds's forskin was to long I laughed at him because I have seen ds when he was erect and he has just the right amount to fit. TO me there is no such thing as to much foreskin unless he can tie it in a bow or around his neck lol.gif: The human body knows what it is going to need down the road and just because there is a lot of it there now dosnt mean it wont be needed after puberty

Ballooning is part of the separation process and is 100% normal. Also pain while urinating is normal during separation as well. If it comes and goes then you can almost be 100% sure that it is due to separation going on. Frequency of urination has nothing to do with the foreskin that would have to do with his bladder or kidney's

I would be concerned about him not being able to urinate at all or just dribbling out. But I have seen ds dribble at then a full stream forms so that can be normal. That dosnt sound like what you described though. It would take years for enough scar tissue to build up to cause the type of issue you are describing. It could be that he is burning some from separation and is holding his urine to the point it only dribbles. Has she put him in the bath or given him a cup to pee in so that if it is burning it will dilute the urine and stop the burn.

The steroid cream is meant for boys in puberty or adult mean not for young boys simply because once you stop it his body will tighten things back up like it was meant to be. I hope she can find another Dr. who is foreskin friendly maybe give her the following information so she can call and see if one is near her. Marilyn can also help her with questions.

NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
info@nocirc.org
Phone: 415-488-9883
Fax: 415-488-9660
http://www.nocirc.org
post #4 of 6

I'm not sure that there is even such a thing as a "redundant prepuce".  What ever foreskin he has is what he should have.  The average age of retraction (in cultures where they do not mess with the foreskin) is 10 1/2. To diagnose phimosis in a child of 4 1/2 is irresponsible at best, in my view.  As the pp suggested, the odd episode of pain is quite likely nothing more than separation trauma - which is borne out by the fact that he baloons when peeing. In other words his foreskin has separated from the glans, but his preputial sphincter is still tight.  I also agree with the pp when she stated that his peeing slowly is likely him holding it to mitigate the stinging in a freshly separated area. My DS did this. I think your SIL should leave it alone and ignore that doctor, since he clearly has a poor knowlege of intact genitalia.

post #5 of 6

Frequent urges are usually associated with urinary tract infections but there can be other causes.  I'd suggest she take him to another doctor if the symptoms persist. A culture should be done to positively identify any pathogen and prescribe a treatment.

 

The steroid treatment (Betamethesone) may work temporarily but as soon as it is discontinued, the normal condition will return if the child is not yet ready for retraction.  Another treatment should be tried as few boys are ready for retraction at 4 years old.

 

"it was also suggested to her that pain might be caused by irritation by urine"

 

Not likely.  The glans and inner foreskin is covered in a special kind of skin called "mucosal skin" that is designed to be wet without harm. Urine willl have no effect on it.  It is exactly the same kind of skin found in the vaginal cleft.

 

" it was also suggested to her that pain might be caused by irritation by urine due to ballooning"

 

This is possible.  Sometimes when the foreskin balloons, it will pull at remaining adhesions and cause tiny tears.  When urine gets into these, it can cause burning sensations.  These typically self resolve in a day or two with no treatment.

 

"diagnosis of “Redundant Prepuce and Phimosis” and that he has a rock hard “phimotic band” that blocks urine flow.

 

Redundant prepuce simply means he has excessive foreskin.  But it is normal for young boys to have foreskin that extends beyond the tip of the penis.  Does it hang down to his knees?  This foreskin that extends beyond the tip of the penis is called the "acroposition" and is totally normal.  I suspect the doctor saw this normal condition and falsely diagnosed "redundant foreskin" to convince her it needed to be cut off.

 

Now, for the "rock hard" phimotic band . . . The phimotic band doesn't get hard, only tightly closed and resistant to opening.  This is another indicator that the doctor was doing a selling job on her.  The normal condition of a 4 YO's foreskin is phimotic.  It will be that way until his body decides it's time for retraction.

 

I suspect the reason for the difficulty in urinating is because the normal adhesions between the foreskin and glans is begining to break down and when the urine gets to it, it causes it to burn and he reflexively clamps off the urine stream.

 

"How fast can scar tissue build up to cause such issues if he had normal flow of urine two weeks ago?"

 

About as quickly as it can build up on your body, a significant time.  However, I suspect she/he is just guessing or about to advocate a circumcision.  It's a profitable procedure and generally accepted by trusting parents.

 

 

 

Frank

post #6 of 6
There is no such thing as a "redundant" prepuce, foreskin or anything regarding male genitals. Redundant means not necessary and of course the foreskin is necessary for normal development. Ask anyone with a tight and painful erection if they think their foreskin was redundant and they will say NO! Don't be fooled by Dr. Cutter and the band of baby torturers. There is zero reason to cut off any foreskin for the problems you mentioned above. I was butchered and the reason on my medical paperwork said "residual redundant foreskin" so now I'm here to help prevent the lifetime of problems I've suffered from happening to new generations of helpless boys. FIND A NEW DOCTOR.
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