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Advice On Ballooning, Buried Penis...

post #1 of 38
Thread Starter 
I am looking for some informed advice. I had previously posted on another thread about my intact son. He has 2 urinary conditions, one of which is called “concealed/hidden penis” wherein the penis is trapped/retracted in the pubic fat pad and therefore, hidden until pressure is put around the area. This has also led to a secondary condition called “urinary ballooning” in which urine becomes trapped by the foreskin and therefore the area “balloons” up until released during changing by applying pressure around the base of the penis…this is an off and on condition caused by the “extra” foreskin that normally would be filled in by penis shaft flipping inwards and trapping urine…we have seen 2 different urologists who have advised us that once he is walking on a consistent basis and using the pelvic muscles it should resolve itself as the fat pad will be gradually reduce. However, the first urologist advised me to retract daily ("with aggression") to help remedy the ballooning (which I did cautiously for a little while but did not feel comfortable about it after everything I've read and stopped because it was obviously uncomfortable for my son as well)...we requested a second opinion and went to Sick Kids in Toronto where we were told that he has slight phimosis due to scarring from the previous retracting and were given a steroid cream to apply daily for 6 weeks to loosen foreskin....we were told to retract once a day to help stretch and also clean because the trapped urine could cause infections. Circumcision was not recommended in this case as it could further complicate the issue if scar tissue is present and as parents we are opposed to anyhow. We completed this steroid treatment several months ago with success in loosening his foreskin but since then it has become quite tight again and I am very reluctant to try retracting even though I have been told to do so on a daily basis. I'm at a total loss as to what I should and shouldn't do now....I have noticed that when I do retract enough to see tip of the penis...the foreskin at the top looks red as well as the area around the urethral opening and it is uncomfortable for my son...most of the time I just apply pressure to release the urinary buildup and just leave it alone...however, since it has been such a long time with this condition (since 3 months - he's now 19 months and still not walking yet!) and I keep hearing from people how important it is to "properly" clean the penis area since he is intact and we don't want complications with infections, etc, etc...I am afraid to retract BUT also afraid not to retract at this point....HELP!!

I have read several articles regarding ballooning and how it's a natural phase of glans seperation but because it started so early with my son (3 months) I'm sure it's has to do with his concealed penis condition and the subsequent "extra" foreskin that flips in on itself and traps the urine. Believe me, I DO NOT WANT TO RETRACT if I don't have to....but I keep getting told that having the urine trapped in there greatly amplifies the possibility of infection and if I don't clean, he'll get multiple infections and end up being forced to have a circumsion. I am confused because the specialists I saw were both paediatric urologists...should they not know the proper care of an intact penis?? Even my paediatrician says to retract..but advises against circumsion. How confusing is this for a new mother......I have a follow up appointment with the urologist in August...I'm afraid I'll get reprimanded for not following their instructions to retract and clean...everyone makes me feel like a bad mother for refusing...even my MIL (my husband is intact, by the way, and was taught to clean under his foreskin to prevent disease...when he was an infant he was retracted by a doctor who said he had phimosis...apparently blood shot out when they did it...afterwards he was fine (??). Scary stuff. Should I be telling the urologist not to retract as well...because they both did...my son cried but there was no blood but there was obviously scarring as we found out later...these doctors (especially specialists) think they're God and to question their methods...forbidden. How do you approach this situation?? They advised me that they would wait until after he's 2 to consider surgery to remove part of the fat pad if still concealed but circumsion was last on the list of options and I made it clear that we were against it...first course of action was steroid cream, which we did....now we wait and see if the fat pad reduces I guess.....considering I keep reading that ballooning is quite normal, no one I have run into has ever seen it...including several paediatricians, care givers (day care centre), nurses, other parents, etc...I feel so alone in trying to figure out what I should be doing.
post #2 of 38
Please don't retract...not even a little bit. Everytime you do, you are risking tearing the skin (even if you do it gently) and that can cause infection. Urine is sterile and does not cause infection when it is under the foreskin. Everytime he pees, anything in there will get flushed out.

Balloning is not a "condition". It is a normal occurance in intact boys and you should do absolutely nothing. Some doctors think it means the boy has phimosis, but this is totally wrong. All it means is that his foreskin has started to separate, but his foreskin opening is still small, which is normal. He will stop ballooning probably when he becomes retractible and maybe before.

Don't worry about his buried/trapped penis for now. If he's chubby, it's probably come out later when he slims down. I'm sure someone else will have more info on true buried/trapped penis (when boys don't outgrow it), but I don't know much on that subject.

Try to find some new doctors. All the advice you have been given is way off. There's nothing wrong with your son's penis and even if the doctors seem foreskin-friendly, because they don't recommend circ, they really aren't because they are having you do all sorts of stuff that could cause problems later.

ETA: No, pediatric urologists/specialists do not always know how to care for an intact penis. In fact, I think more often than not, in the US, they are going to be just as ignorant as a regular ped.
post #3 of 38
It does sound like there might be an actual problem with your son. Ballooning is normal, but the urine is supposed to be able to completely exit the foreskin at the end of urination. You wrote that the urine stays ballooned under the foreskin until you manually squeeze it out from the base of the penis at diaper changes. The only time I've ever read about that was when another mom posted some time ago and her son ended up being diagnosed with megaprepuce.

Normally the inside of the foreskin attaches immediately behind the corona (the ridge of the back of the glans). But in megaprepuce, the inside of the foreskin attaches at the base of the penis, so the open space under the foreskin actually extends down the whole penis.

The only correction I am aware of is surgery. Talk to the pediatric urologist about megaprepuce. If this is what he has, and surgery is elected, ask if they can preserve a normal amount of foreskin so he doesn't look circumcised afterwards.
post #4 of 38



This quote seems to apply to your son:
"Usually the greatest problem an intact boy will ever have is that someone thinks he has a problem."



Dr. Fleiss, a prominent pediatrician in L.A., has this to say about ballooning:


"Ballooning of the foreskin during urination is a normal and temporary condition in some boys. Ballooning comes as a surprise only to those adults who have no experience with this phase of penile development. It certainly does not cause kidney damage; it has nothing to do with the kidneys. Ballooning disappears as the foreskin and glans separate and the opening of the foreskin increases in diameter. It requires no treatment. "


Your son doesn't have "extra" foreskin. He has exactly the amount of foreskin he is supposed to have. And trying to get his foreskin to stretch or loosen up is comparable to trying to stretch and loosen the vaginal area of a girl....we'd consider that child abuse, right?


You can email Dr. Fleiss directly at Fleiss AT usc.edu (obviously take out the spaces and replace the "AT" with the @ sign.)

Or you can call Marilyn Milos, a nurse who knows a lot about intact boys, at 415-488-9883.
post #5 of 38
I wouldnt talk to them about megaprepuce until you see if the buried penis resolves when he starts to loose the baby fat ie when he is a few years old.

I would be terrified to send my son in to have a "little" foreskin removed since even a little can cause numb areas and he would loose valuable parts of the foreskin.

Even with the urine sitting in there it wont hurt anything since it is sterile and sometimes it does stay in there for a bit. It just isnt that big a deal.
post #6 of 38
Quote:
Originally Posted by MCatLvrMom2A&X View Post
I wouldnt talk to them about megaprepuce until you see if the buried penis resolves when he starts to loose the baby fat ie when he is a few years old.

I would be terrified to send my son in to have a "little" foreskin removed since even a little can cause numb areas and he would loose valuable parts of the foreskin.

Even with the urine sitting in there it wont hurt anything since it is sterile and sometimes it does stay in there for a bit. It just isnt that big a deal.
:
post #7 of 38
Yes urine is sterile when it comes out, but it is a good medium for bacterial growth if it pools over long periods. That why people who can't neurologically empty their bladders completely or people with various anatomical twists of their urinary plumbing are more likely to get UTIs. OTOH, it is the regular flushing of the normal urinary tract with sterile urine many times as day that works against infections taking hold.

Sounds like your son's ballooning in combination with the buried penis is making for more trapping than is typical with just straight ballooning. It may be keeping the urine from exiting the preputial space with gravity as would typically happen. The ballooning and buried penis will in time resolve themselves, as the foreskin separates more completely from the glans and he gets more active and the fat pad goes away. But the fact that you have to express the urine perhaps does indicate a higher risk of bacterial growth under there, so other measures than doing nothing might be in order.

I can see why the docs might THINK they should try to hasten his retractability to get him through this phase quicker, but obviously the steroid cream is only a temporary fix (and you wouldn't want to keep doing it continuously), and the forcible retracting carries risk of multiple harms, and goes against every reasonable care recommendation for intact penises. (See NOCIRC Brochure #6 on Forcible Retraction: http://www.nocirc.org/publish/6pam.pdf).

I do not have the medical knowledge to say much more about this. The only thing that seems reasonable to me is to continue to express urine each time you change his diaper. I would definitely not be retracting (especially not "with aggression" - YIKES!). And I second the suggestion to contact Dr. Fleiss who is super knowledgeable, foreskin-friendly, and happy to help.

The good thing is, your son has had no problems from this even though he's had it for 16 months already! And don't worry about the pinkness of the inside of the foreskin and the tip of the head of the penis - this is their normal color, not a sign of infection. And don't let anyone give you a diagnosis of phimosis. It is completely normal for the foreskin opening to be tight and closed at this age. Whether any scarring damage has been done by the previous retraction is probably not something that can be definitively known at this point, so don't fixate on that. Also, re: care of the foreskin, the correct care for a child of this age is to wash off the outside, period. Once the foreskin is retractable and he is developmentally ready he can learn to retract, rinse underneath, and replace to the foreskin back forward, occasionally in the bath (more regularly by puberty).

This will all be behind you one day!

Best wishes, Gillian
post #8 of 38
My three boys have/ had the buried penis. They were chubby babies. This went away when my first two turned 3. They're lean now. My 11wker is still chubby and cute as a button! There is nothing to worry about the buried penis issue. That will resolve when they're older. I do understand the worry because I worried about that too when I discovered it when ds#1 was a baby.

It sounds to me like your son's doctors set this up for you to have surgery. You can avoid surgery! Absolutely in no way should anyone retract a boys foreskin except for the boy himself. You have good instincts. My son's Jewish pediatrician retracted ds#2 and he became red at the tip. I thought it was infection and called Marylin Milos. No retraction! Its what caused it to become red and I'm sure if I followed up with the Pediatrician about this he would have recommended surgery. This is a guy who said circ wasn't necessary! The foreskin has an amazing ability to heal. ds#2 thought "ballooning" was fun. Thats normal too. Hugs to you mama. I hope all goes well for the little guy.
post #9 of 38
Thread Starter 

Thanks Again!!

Wow...thanks to everyone here for all your support. : I definately know that my son has a more complicated condition than just the natural ballooning but I'm just wondering now how to I deal with the urologist whom I KNOW will retract and will reprimand me for questioning him (since I already did at our previous appointment where I showed up with a file folder full of medical journal articles in relationship to buried penis...god forbid you ask questions and take control of your own/son's health!!) Anyhow....how do you deal with these professionals that insist you retract, etc....??

I have sent email to Dr Fleiss. Looking forward to hearing back from him.
post #10 of 38
Personally unless he develops more of a problem like not being able to pee or does get a infection I wouldnt take him back the the urologist right now. There is nothing they can do but cause more harm at this point any way so if it were my son I wouldnt go back.
post #11 of 38
At least you got good advice on the circ from your doctors. It would be the worst thing you could do for a buried penis.
post #12 of 38
Quote:
Originally Posted by NewMomBevW View Post
Wow...thanks to everyone here for all your support. : I definately know that my son has a more complicated condition than just the natural ballooning but I'm just wondering now how to I deal with the urologist whom I KNOW will retract and will reprimand me for questioning him (since I already did at our previous appointment where I showed up with a file folder full of medical journal articles in relationship to buried penis...god forbid you ask questions and take control of your own/son's health!!) Anyhow....how do you deal with these professionals that insist you retract, etc....??
I have sent email to Dr Fleiss. Looking forward to hearing back from him.
You fire them. You kindly ( or not so kindly) inform them that their view on your son's physical state does not line up with yours and you don't agree with the treatment plan and you will be seeking another physician who is more foreskin friendly and knowledgeable about how to help your son. That's how you deal with the "professionals".
post #13 of 38
Thread Starter 

"professionals" & Such....

Whew...that's a tough/uncomfortable position to be in to have to stand up to these professionals that think that their opinion is the educated, correct one and that as parents we are ignorant and misguided if we disagree with them. Is there anything I can print or quote to back up my arguement...obviously something by a medical professional would be preferable otherwise they will just discount it.


FRUITFUL WOMB....did your sons experience the ballooning while they still had the buried penis condition? Did they have any problems with infections, etc? What we you advised to do and how did you deal with it? Do you know if it's painful for them while they're swollen? Sometimes my son gets REALLY swollen and it takes a while to express all the urine out....sorry if I'm hounding you with questions but I have not yet encountered another mother who has experienced this besides you so I'm just picking your brain here...

I've attached a couple pictures as to what my son's condition looks like...the first is the buried penis...it looks like there is no penis but upon pressure around the base....sure enough, out pops a normal-sized penis (actually the urologist told us that it was a bit larger/thicker than normal---much to my DH's delight... ). The second is what it looks like when it balloons up with urine. Please advise if this is what your sons' condition looked like....
THANKS SO MUCH!!

http://img.photobucket.com/albums/v302/Bevie01/i9.jpg BURIED

http://img.photobucket.com/albums/v3...Ballooning.jpg
post #14 of 38
Wow I have never seen anything like those pics before. I hope you hear back from Dr. Fleiss soon.
post #15 of 38
Also you can email Marilyn Milos if you don't want to call her:

info@nocirc.org
post #16 of 38
Just wanted to give you some and hope you can get some sound advice from a doctor that knows what they are talking about! My son also had a buried penis (looked just like your 1st pic) and it started coming out at around 2 years old.

I also second the recommendations not to retract! Does the urine drain enough by just pushing to let the penis emerge from the fat-pad (without retracting foreskin, of course)? Like a pp mentioned, urine is sterile while in the bladder, but once out bacteria can thrive in it. Also the change in urine pH as urea converts to ammonia can burn the skin and *particularly* any wounds caused by aggresive retraction. Though I'm no expert, it sounds like frequent draining of the urine followed by a rinse (saline would probably be best especially if there is already irritation) should tide him over until his penis emerges more.

Good luck and I hope you can get some answers soon!
post #17 of 38
Quote:
Originally Posted by NewMomBevW View Post
Wow...thanks to everyone here for all your support. : I definately know that my son has a more complicated condition than just the natural ballooning but I'm just wondering now how to I deal with the urologist whom I KNOW will retract and will reprimand me for questioning him (since I already did at our previous appointment where I showed up with a file folder full of medical journal articles in relationship to buried penis...god forbid you ask questions and take control of your own/son's health!!) Anyhow....how do you deal with these professionals that insist you retract, etc....??

I have sent email to Dr Fleiss. Looking forward to hearing back from him.
Yes, cancel the appointment with the urologist and find a new specialist that will provide better care for your family. You shouldn't have to deal with anyone that makes you uncomfortable. Good luck!
post #18 of 38
i agree dont go back there is nothing they can do but cause more harm to your son..........
i am not sure what advice can really be given in your dc's care but i will try i am not sure how much the ballooning is with your ds how does he pee without a diaper on could diaper free time be a idea this way he will have more time to able to play with his penis the idea is that maybe with him playing with it the foreskin will be come looser and this eliminate the ballooning as for combating the possibility of infrection i would say daily baths (soaking in water)
post #19 of 38


I think littlemizflava might have something. If you could get him to pee in a potty it might help with the urine getting trapped. The diaper pressing on the foreskin could be part of the problem.

They might be able to help you with getting him to use a potty over in the Elimination Communication forum.
post #20 of 38
Quote:
Originally Posted by NewMomBevW View Post
FRUITFUL WOMB....did your sons experience the ballooning while they still had the buried penis condition? Did they have any problems with infections, etc? What we you advised to do and how did you deal with it? Do you know if it's painful for them while they're swollen? Sometimes my son gets REALLY swollen and it takes a while to express all the urine out....sorry if I'm hounding you with questions but I have not yet encountered another mother who has experienced this besides you so I'm just picking your brain here...

Please advise if this is what your sons' condition looked like....
THANKS SO MUCH!!

http://img.photobucket.com/albums/v302/Bevie01/i9.jpg BURIED

http://img.photobucket.com/albums/v3...Ballooning.jpg
Thank you for the pictures. I have to be completely honest with you. My first son did look like that (the "BURIED" picture) but he was circumcised. Because he didn't have any foreskin he wasn't ballooning. Please allow me to vent for just a moment...

He was circumcised against my wishes- in the hospital. I take blame for what happened to him and nearly lost my life over this tragedy.

My son already had gone through so much. How could I take his mother away too.

Ds #1 had skin attached to the glans after his brutal incident. I was advised to pull the skin apart-away from the glans. I dared not to. No one told me but I had a feeling that if I left it alone the skin would grow as he grew. Then maybe he wouldn't be so tight when he had erections as an adult. It separated on its own time. He has meatal stenosis and had the buried penis. Its not buried anymore. I feel so awful now that I'm reliving this pain. I have so much WRATH against the doctor and the hospital where he was born.. I don't think I'll ever get over it. The lawyer said he is afraid to come to TX because there is a cap on how much a doctor can be sued, thanks to the new law here, I went to this particular lawyer because he won a case like mine before. This lawyer said he would charge me $300k. Thats the cap. If I win, he would take everything. If I loose I would be in a lot of debt! Isn't that just lovely: I have more to say for another day and probably somewhere else on MDC. I'd hate to hijack your thread.

I can tell that a lot of mothers here are on the edge of their seats on this issue, including myself.

Ds#2 and #3 They have very long foreskins. As chubby babies it looks like all they have is foreskin because the penis is buried. There is very little space between the foreskin and the glans so when ballooning occurs it isn't as pronounced.

It sounds like your scared that these doctors are going to harm your son. I would NOT go back to them. Find or make stickers that say "I'm intact, Don't Retract!" and put it on his diaper

I have faith that your son will be okay. But I encourage you to call or write to Marilyn Milos info@nocirc.org415-488-9883 Send her the pictures you showed to us. Please please keep us posted. I won't be able to rest until I know everything is okay.
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