58 P.P. Godbole
FIGURE 6.2. Balanitis Xerotica Obliterans: shutter type foreskin with obvious sclerotic margin that does not pout on gentle retraction.
the foreskin. In older pubertal children with a healthy non retractile foreskin, a preputioplasty may be considered.4
2.Localised collection of smegma pearls: No intervention is necessary.
3.Inflammatory conditions: balanoposthitis, balanitis, posthitis: Simple bathing, topical steroids, and antibiotics. If recurrent disabling attacks of balanoposthitis occur despite conservative management, a circumcision may be considered.
4.Balanitis Xerotica Obliterans: Circumcision.
5.Paraphimosis: Reduction with or without an anesthetic.5
6.Hooded foreskin: without hypospadias: no treatment, modified circumcision or foreskin reconstruction. If with hypospadias: no treatment, modified circumcision or foreskin reconstruction with hypospadias repair.
6.4 Indications for Referral
1.Recurrent severe balanoposthitis where conservative management has not been successful.
Chapter 6. Disorder of Male External Genitalia |
59 |
a
b
FIGURE 6.3. (a, b) Paraphimosis. Note the constricting band at the coronal sulcus.
2.Balanitis xerotica obliterans.
3.Paraphimosis where reduction is not possible with simple manual reduction.
4.Hooded foreskin with or without hypospadias: If parents wish surgery for cosmetic/functional reasons.
60 P.P. Godbole
FIGURE 6.4. Hooded foreskin with distal hypospadias.
References
1.Gairdner D. The fate of the foreskin. BMJ. 1949;2:1433-1437.
2.Escala JM, Rickwood AM. Balanitis. Br J Urol. 1989;63:196-197.
3.Ashfield JE, Nickel KR, Siemens DR, et al. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003;169(3):1106-1108.
4.Cuckow PM, Rix G, Mouriquand PD. Preputialplasty: A good alternative to circumcision. J Pediatr Surger. 1994;29:561-563.
5.Barone JG, Fleisher MH. Treatment of paraphimosis using the puncture technique. Pediatr Emerg Care. 1993;9:298-299.
Chapter 7
Disorders of Male External
Genitalia: Hypospadias,
Epispadias, Concealed Penis,
and Urethral Disorders
Mark R. Zaontz
Key Points
››Diagnosis should be made at birth. Hypospadias is easily recognized by an incomplete hooded foreskin appearance and urethral opening anywhere beneath the tip of the penis. Hypospadias may or may not be associated with penile curvature.
››Circumcision is contraindicated when the diagnosis of hypospadias is made.
››The most common associated anomalies include undescended testes, hydroceles and/or hernias. Screening renal ultrasound is not routinely recommended unless there are other midline defects and/or if the hypospadias is proximal.
››In cases with undescended testes it is important to obtain a karyotype at birth, as there is a high incidence of intersex in this scenario.
››Beware of a complete foreskin hiding a hypospadias condition. Hence, there must be full foreskin retraction prior to performing circumcision to properly identify the meatal location.
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Surgery in Clinical Practice, DOI: 10.1007/978-1-84996-366-4_7,
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