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hi - new here - question - Page 2

post #21 of 42
Thread Starter 
Quote:
Originally Posted by Frankly Speaking
Buried penis is a complication of circumcision so it's something you don't need to worry about. Some boys will have a penis that is held closely to the body and others will have a penis that hangs loosely away from the body. Both are within the range of normal and it sounds like your son has one of those that are held closely. As he gets older, this will become less noticeable as the penis grows and the fat on the pubic mound becomes less. When he has an erection, he will reach his full erectile potential regardless of the size when flaccid.




Frank
whew. thanks frank. that is such a relief to hear.

you'd think after figuring out how to have a baby i'd know something about penises. nope!

i will keep you all updated once we have our appt.

thank you again for the support! it is so incredible to have a resource like this!
Stella
post #22 of 42
Thread Starter 

question- Update~~

Hi everyone,

I just got back from our visit with Dr. Betts at Children's hospital Oakland. He is great! The first thing he told me is "I know that William is uncircumsized and I want you to know that I am against circumcision". How great is that???? Then, he looked at the photos I took (to ensure that he would see what we saw even if it didn't present itself right then) and then looked at William. He took off his diaper, examined his penis WITHOUT RETRACTION, and said - William has phimosis. he does NOT have congenital megaprepuce. Congential megaprepuce is when the skin does not move at all, his does. What is causing the swelling is trapped urine in the foreskin. Here is a prescription for betamethazone cream. Lets use that for a month and see if it will losen his foreskin at all. If it doesn't I am concerned about balantitis (sp?) and that is much worse if his penis or glans gets infected. if this doesn't resolve, we should talk about a dorsal slit which should losen up the foreskin without circumsision.


I asked him if this was more common since William was a preemie and he said no, its because William is William. I also asked if William's penis was normal size and he said yes, his penis is normal size, you don't have to worry about that.


I am very happy with this visit. I am going to cancel the other urologist appt I have and stay with Dr. Betts.
post #23 of 42
Hmmmmmmmmm, I don't know. Based on what this doc is telling you now, it sounds like normal ballooning to me. Unfortunately, the doc is not altogether right in his diagnosis either. It is impossible to diagnose phimosis in a baby as young as yours. It is perfectly normal for a baby to have a small foreskin opening and to balloon when he pees. Mine does(my ds2 anyway) and we were assured by a couple of docs that he is perfectly normal. Our first ds didn't start to balloon until he was around three so we were concerned when we saw it in our baby almost from birth. Neither of them has ever had an infection or "balanitis" and noone has ever suggested a surgery or even a cream to correct this condition, because it really isn't a condition, it is normal development.

Here is some info on this for you:
http://www.cirp.org/library/normal/
http://www.cirp.org/library/normal/aap/
http://www.mothering.com/articles/ne...uncircson.html

I hope this is helpful to you.
Take care,
Tara
post #24 of 42
the phimosis ? again I have read here many times that it is impossible to diagnose phimosis in a infant because almost all have a non retractible forskin and that is what the term phemosis means. I guess in this case the dr is saying that the opening is super tiny?? Have you ever seen him pee what does the urine stream look like. Kinda thick or is it just a tiny jet like pin size? Maybe frank will come back in and shed some light on what I am missing here.
post #25 of 42
Thread Starter 
Hi Tara,

What William has is not normal ballooning. the dr said everything you did too - about what is "normal" in boys and it being normal not to retract. Unfortunatly, William is not presenting as ballooning. if you read my original post, you will see that he has major swelling to the point he cannot pee sometimes. is this what your boys experienced as well?
post #26 of 42
No I guess I forgot the detail about not being able to pee. My younger ds has had urine trapped under his foreskin for a while, like from one diaper change to the next, but we have never had to force it to come out. It just went away between diaper changes(maybe 2 hrs). I guess what I am not understanding is what is abnormal about William. What is the doc saying will cause these infections? Urine is sterile until it is exposed to the air, so is he concerned that something is getting into the foreskin to contaminate the space between the foreskin and the glans? If that is the case, how would making his foreskin opening larger remedy that? I guess I am just concerned because it has been seen quite often here that docs suggest manipulating a babys foreskin without real need which leads to more problems than solutions.

I am glad that you are happy about what this doc had to say though At least he is not one of those who brought out the scalple on the first visit.

Good luck to you guys!
Tara
post #27 of 42
I found this,

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

"Two infant boys presented with a tight congenital phimosis resulting in an excessively baggy, urine-filled prepuce and a swollen scrotum. Compression of the scrotum resulted in drainage of urine."

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

"CM is a striking condition which cannot be easily missed or hidden; we propose that it is a newly emerging and distinct condition which should not be confused with a buried, concealed, webbed, trapped or micropenis. Early surgical correction is recommended and circumcision should be avoided."

Also:

http://www.blackwell-synergy.com/doi...x.2001.0003c.x (Contains some pictures.)

HTHs,

Jen

Edited:

Sorry, I didn't see the update when I posted this. Regarding phimosis-is there any chance he was forcibly retracted in the NICU or during catheterizations? It sounds like he had a lot going on. If he had a lot of trauma to his penis during that time, it's *possible* he could have true phimosis. But if he wasn't forcibly retracted and hasn't had any infections I would take the doctor's 'diagnosis' with a grain of salt. It's totally normal for an infant to have a tight foreskin, and retraction doesn't 'need' to happen anytime before puberty. I'd suggest a second opinion, perhaps D.O.C. or NOCIRC could provide a referral to a truly foreskin friendly and knowledgable physician. I wouldn't use the cream unless you are confident he really has phimosis. There's no reason a 10 month old *needs* to be retractable.

Jen
post #28 of 42
I think I'm begining to get a better picture of what the situation is now.



Quote:
Originally Posted by kondonis
He took off his diaper, examined his penis WITHOUT RETRACTION, and said - William has phimosis.
Of course he does! That's the normal condition for a baby this young. But, that is not a reason for concern, just an indication that William is normal.


Quote:
he does NOT have congenital megaprepuce. Congential megaprepuce is when the skin does not move at all, his does.
That's good! At least that is ruled out and that gives me a little bit more information.


Quote:
What is causing the swelling is trapped urine in the foreskin. Here is a prescription for betamethazone cream. Lets use that for a month and see if it will losen his foreskin at all.
Now, this is where we begin to disagree. Yes, I imagine he is right that it is urine trapped in the foreskin but that is not a cause for concern. The lay term for this is "Ballooning" and it is common for boys as they near the time for the foreskin to retract. Since the process has already begun, let's let it progress as William's body dictates instead of forceing Williams body to do what we think it should do.

The thing that initially threw David and me was when you described William's penis as "pyramidal" in your first post. What I imagine is really happening is that William's penis is held closely to his body when flaccid with most of the shaft held in the pubic mound. It also seems that William's foreskin is completely or mostly released from his glans so that when his foreskin fills with urine, it is filled all of the way down to the base of his glans and with the closely held penis, it looks pyramidal because the base of the glans is at the pubic mound.


Quote:
If it doesn't I am concerned about balantitis (sp?) and that is much worse if his penis or glans gets infected.
We've had many, many Moms here describe ballooning and never an infection. Urine is sterile except when there is a UTI, so I see no need to worry.


Quote:
if this doesn't resolve, we should talk about a dorsal slit which should losen up the foreskin without circumsision.
I also disagree with this. First, it is highly unlikely and if on the remote chance it does happen, you cure it with antibiotics, not surgery. What the doctor is talking about is cutting the foreskin opening. If a daughter had a vaginal infection, would you allow a doctor to cut her vaginal opening? Certainly not! This would leave her with a vaginal opening that just hung open and would have no tightness at all. It will do the same thing for a boy. He will end up with a foreskin that just hangs open instead of tightly hugging the glans. This is simply the incompetence of the doctor showing.


Quote:
I asked him if this was more common since William was a preemie and he said no, its because William is William. I also asked if William's penis was normal size and he said yes, his penis is normal size, you don't have to worry about that.


I am very happy with this visit. I am going to cancel the other urologist appt I have and stay with Dr. Betts.
Actually, in contrast to what I wrote above, I agree with that. It appears that Dr. Betts is on board with you and I can imagine you can provide him with the information he needs and he will accept it and trust your instinct. I think he might be a diamond in the rough but a diamond never the less and diamonds can be polished.


Frank
post #29 of 42
Frank, didn't someone (maybe it was you?) post a link here awhile back that showed pictures of the dorsal slit surgery on a child? I had no idea how it was done, and it was really eye opening. I think most of us think of a dorsal slit as a little snip with a scissors, but this link explained it as a triangular piece of foreskin being removed. I wish I'd saved the link.

Jen
post #30 of 42
It wasn't me but I do remember it. There are differing degrees of this though from just a slight cut through the ridged band/frenar band/preputial sphincter to what is termed a "dorsal slit circumcision" where the foreskin is split to the base of the glans. This produces a very unsightly mess. While it does not remove any of the foreskin and preserves the frenulum, it leaves the entire foreskin hanging from the underside of the penis. It looks like some kind of baggy growth hanging from the penis. Fortunately, it is rarely performed.


Frank
post #31 of 42
Thread Starter 
Quote:
Originally Posted by Frankly Speaking

Now, this is where we begin to disagree. Yes, I imagine he is right that it is urine trapped in the foreskin but that is not a cause for concern. The lay term for this is "Ballooning" and it is common for boys as they near the time for the foreskin to retract. Since the process has already begun, let's let it progress as William's body dictates instead of forceing Williams body to do what we think it should do.

The thing that initially threw David and me was when you described William's penis as "pyramidal" in your first post. What I imagine is really happening is that William's penis is held closely to his body when flaccid with most of the shaft held in the pubic mound. It also seems that William's foreskin is completely or mostly released from his glans so that when his foreskin fills with urine, it is filled all of the way down to the base of his glans and with the closely held penis, it looks pyramidal because the base of the glans is at the pubic mound.

Frank

Frank - what you say above sounds more like William - but won't the cream help resolve the ballooning? what could it hurt?
post #32 of 42
If there is nothing wrong (which sounds like there's not), why would you WANT to do anything? Steriods are not something to be casually messing around with, they can cause issues if not needed (and even when needed).

ETA: Also, why would you want to use a steriod cream to speed up a natural process that takes as long as it does on purpose? If you get your son to be retractable now, he will be getting the inside of his foreskin, his glans, and urethra all exposed to feces and urine on a daily basis. The foreskin is adhered to the glans to protect it from that stuff. Don't mess with nature.
post #33 of 42
Quote:
Originally Posted by kondonis
Frank - what you say above sounds more like William - but won't the cream help resolve the ballooning? what could it hurt?
Well, yes, maybe, but would you think it a good idea to help a newborn puppy or kitten get their eyes open or should you just let nature take it's course?

Ballooning is a natural condition that happens according to the boy's preprogrammed instructions. For retraction to happen, two things must happen. The foreskin has to separate from the glans and the non-elastic tissue around the foreskin opening has to be replaced with elastic tissue by the boy's body. Those two things can happen in either order. If you force either one, you can cause damage. If you force the opening, you can cause tears in the structure and in the skin surface. The tears in the surface can make openings for infection. Tearing the structure can cause acquired or pathological phimosis that will make retraction later difficult or impossible. Just like the puppy's or kitten's eyes the foreskin is tight for a reason and just like the eyes, the foreskin will open according to nature's instructions and on it's own schedule. Just be patient.



Frank
post #34 of 42
Listening to the NOCIRC tape of John Taylor, M.D. the other night was very interesting. He said that there are cells that are like spirals that whirl to create the preputial space. So, it's not really that the foreskin separates from the glans, it's that the body forms a space between the foreskin and the glans and that can take up to 17 years to complete forming. The human body is sure amazing. We think it's amazing that women can grow and give birth to a baby---men can form spaces! Wow.
Baybee
post #35 of 42
Thread Starter 
just a quick update....

I weighed all the information I was given and I decided that I would go ahead with the betamethasone cream. I have given it to him every other night or so (to prevent irratation) and i have noticed in all that time that not once has he had the painful swelling that I wrote about in the OP.

It was important for me to be able to take away the pain and obvious discomfort that this swelling was causing him. Whether or not this condition is normal, it doesn't happen to most kids like it was happening to William and I HAD to do something about it - I could not just sit there while he cried because he couldnt pee and his skin was turning purple.

that being said, the betamethasone has loosened him up so he now can pee like a normal intact boy - which was my goal. I only wanted it loosened to be able to pee normally, so I am using the betamethasone cream very sparingly, so it only opens JUST enough, not all the way.

He will NOT be circumsized for this - no dorsal slit either. I have yet to make a follow up appt with Dr. Betts since this seems to have resolved the issue -

thank you for your advice here - I would not know anything about this were it not for you. he still has a bit of urine trapped but it is so small I am not worrying about it per the info I received here.

thanks again - Stella
post #36 of 42
That's great news! Thanks for the update. I hope everything continues to go well!
post #37 of 42
Stella, it sounds like you have carefully and fully thought this out and I support you in your decision.

I do want to give one additional piece of advise. When the betamethesone cream is used and then discontinued, often the prepuce will close slightly and it may appear that the opening is closing again and to many, that appears to be a failure of the treatment to work properly to resolve the condition. I suggest you go a little beyond the minimum to resolve the condition so as to give a little room to contract.

Please let us know how he's doing.



Frank
post #38 of 42

Hi all. I am new to this site. I know it has been a while since the last post on this topic... however I really need some help. Has anyone ever had to deal with Congenital Megaprepuce? My son (4 months old) has just been diagnosed. Each time he pees, the base of his penis swells up into a ball and I have to manually compress it for the urine to be released.

 

I am interested to hear if anyone has had a similar experience and how they dealt with it? Did it resolve itself? Is it possible to treat without surgery? The surgery itself looks extremely disturbing... The original poster of this message seems to have had some luck with applying a steroid cream (I tried to PM her but I'm having technical issues....) I am currently trying the cream, but so far no results (it's only been 1.5 weeks since beginning the cream).

 

Hoping someone can help. Thank you.

post #39 of 42
It dosnt appear that there is a lot of information out there on this condition as it seems to be pretty rare. I would contact NOCirc and Marilyn Milos I am sure that they will be able to point you in the right direction so as to preserve as much foreskin as possible for your ds.
post #40 of 42

I agree there's not a lot of info out there.  I read through this whole thread & I agree w/ contacting either Marilyn or the doctors at www.doctorsopposingcircumcision.org .  There's been quite a bit of time since this thread was originally started so I imagine there've been more cases of this for them to know about.

 

I would say too, that if you are not practicing elimination communication, it could help the two of you to deal with this.  If you are unfamiliar, here's more about it www.diaperfreebaby.org & there was, at one time, an EC board here, under diapers I believe it was, that may be helpful.  Little babies pee a lot - I'd be shocked if you were getting every pee of his if you are using diapers in the conventional sense - changing every couple to few hours.  Babies often pee right after waking, & then a couple or more times w/ in 30-60 minutes & then w/ nursing, so it ends up being a lot.  If you know when he's got to go, you can help to make sure he is able to get the pee out.  Feel free to ask me questions about it.  I EC'd two children, one from age one until he was a grad & the other from 3 days old.  It really ended up being a lot of fun - it's awesome to have your kid do their business where you want them too w/ almost no clean up!

 

Best wishes,

Sus

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