hypothetical...

[bluetoes]

OK. So your son is born with a relatively severe hypospadia. At near to one year a few MD opinons tell you without surgery he will never function normally, which includes sexually. He was only born with half a foreskin anyway, a good part which needs to be used in the repair. So while they're at it you have the tiny remaining bit trimmed, creating a circumcised boy who would never know he any different from the average American male. What would you have done differently in this situation? DH and and I discussed and despite him being intact and both of us being complete intactivists we think we'd opt for the same option. What would the rest of you do?

[tlh]

i would have the hypospadia fixed and then have foreskin restoration done.this is how The Australians do it.

Foreskin restoration in Australia comes about in a variety of ways. Sometimes a baby boy is born with an incomplete foreskin, which affects one in 300 births. Occasionally a boy is born with the opening to the urethra located on the underside of the penis, preventing a normal erection. And then there's the parents expressing concern over the cosmetic appearance of their little boy's penis. What if you don't want the "circumcised look"?


http://www.salon.com/health/sex/urge...12/baby_penis/

[MCatLvrMom2A&X]

If the hypo was way down on the shaft I would opt to have it fixed but I would insist that any foreskin that they didnt have to use would be left alone. Even a little bit of foreskin is a thousand times better than none.

[JSerene]

I would have done the same thing. The benefit is it will look symmetrical/cosmetically normal.

[llamalluv]

Question?

I will probably go look into this a bit later, but....

Why do they have to cut bits of the MOST SENSITIVE skin on a child's body to reconstruct his penis? Couldn't they use skin from another part of his body to use? Preferably something that won't be another open wound exposed to urine and feces in the diaper?

[thixle]

stupid question

why wouldn't they use a "donor" foreskin to repair it? Really, you would think... why would they have to use that kid's hypothetically half-formed foreskin?

[Organicavocado]

^VERY interesting question.

[perspective]

Originally Posted by thixle

why wouldn't they use a "donor" foreskin to repair it? Really, you would think... why would they have to use that kid's hypothetically half-formed foreskin?

Because, just like with all forms of surgery, with taking tissue from someone else body, there is a high possibility that the body may reject the new tissue, because its foreign. And its really bad when tissue in that situation is rejected.

[tlh]

Originally Posted by llamalluv

Question?

I will probably go look into this a bit later, but....

Why do they have to cut bits of the MOST SENSITIVE skin on a child's body to reconstruct his penis? Couldn't they use skin from another part of his body to use? Preferably something that won't be another open wound exposed to urine and feces in the diaper?

they use the foreskin because the inner foreskin is a mucous membrane. mucosa can be used from the lining of the mouth.

http://www.sciencedirect.com/science...a42e509c9f8a0e

The oral mucosa is a viable source of donor tissue displaying many characteristics of the ideal urethral graft. There are numerous variations of the oral mucosa graft urethroplasty technique. Herein comparisons are made.

scrotal skin can also be used.

http://www.hypospadias-surgery.com/engl_hypo_1.htm



To correct hypospadias and achieve a terminal meatus, one may use one of the following basic principles or tissues: 1) mobilisation of the urethra; 2) skin distal to the meatus; 3) skin proximal to the meatus; 4) preputial skin; 5) combined prepuce and skin proximal the meatus; 6) scrotal skin; 7) dorsal penile skin; 8) different grafts.

[phdmama06]

Hmmm...I'm really not sure, but I'd think that it would be useful to save any bit of foreskin that is left, on the principle that some is better than none. It's something I have never seriously thought about.

[thixle]

Originally Posted by perspective

Because, just like with all forms of surgery, with taking tissue from someone else body, there is a high possibility that the body may reject the new tissue, because its foreign. And its really bad when tissue in that situation is rejected.

The only problem I have with this is-- there is a high possiblility of rejection, period. ALL skin grafts are foriegn material. My cousin had skin grafts (she had a "phantom twin" that was absorbed into her chest). They tried to use her own skin as a graft (carefully prepared), but in the end, only the synthetic skin took (and it was probably formed from foreskin, from what I've read recently). I don't know how common this is.
Either way, it is bad when tissue is rejected, but it can happen for a number of reasons (like lack of circulation), and just because it is from the same body, doesn't necessarily mean it WON'T be rejected.

It's my understanding (from a few web resources) that in hypospadia, the doctors are constructing an internal urethral extension- a longer tube for urine to flow through. So it makes sense they would only take mucosal tissue. But I do know that when it comes to skin grafts, donor tissue is not so bad.... especially when there are no other safe alternatives for harvesting tissue from the origional person. How safe would it be to harvest the inner cheek of a nursling? How practical is that if there isn't enough of the hypothetically half-formed foreskin to do the full procedure (remember, this is relatively severe hypospadia)? Or what if there were only a small "bulb" of foreskin, not even a half?

I'll stop there because my spelling is atrocious and I don't think I'm making sense through the sinus meds... but I think you see my point. Hospitals have a steady supply of fresh, healthy, blood-type compatable, neonate foreskin. I assumed this would be the first place one would look for hypospadia repair, beyond the origional patient.

[eepster]

Originally Posted by llamalluv

Question?

I will probably go look into this a bit later, but....

Why do they have to cut bits of the MOST SENSITIVE skin on a child's body to reconstruct his penis? Couldn't they use skin from another part of his body to use? Preferably something that won't be another open wound exposed to urine and feces in the diaper?

I know that in a form of plastic surgerywhere they reconstruct a severed nose they use skin from the forehead instead of somewhere inconspicuos. This way they do not have to completely sever the skin they just flip it down leaving some of the blood supply and nerves intact. It's more like a skin shift than a skin graft.

Is it possible that they move the fore skin to the underside of the penis without cutting off the blood supply?