DORSAL SLIT RECOMMENDATION
My son was born with phimosis -- foreskin too tight and sealed from
the inside with skin adhesions. He was able to pee ok but his pediatrician
told me from day 1 that he likely would start to have problems as he
got older. They suggested I try to stretch the opening gently. This
is a very delicate part and I did try for a few months when he was
a baby but it didn't make any difference. (IMO you'd need to fit an
instrument in there to have any chance at stretching it and I was not
about to try anything like that.)
A few months ago, at age 3.75, he started having itching and irritation.
I did not want him circumcized for all the usual reasons. Instead the
pediatric urologist did a "dorsal slit procedure." Richard was put
under a general anesthetic in the hospital and a small, straight incision
was made along the top of his foreskin and then it was stiched up.
They gave him a caudal block (in the caudal space of the spine) and
that did not wear off for 10 hours (approx.) so he never complained
of pain. He had a lot of swelling but did not complain of pain and
was back in daycare a few days later. Now the swelling has gone down
and the stitches have fallen out. Cosmetically he looks very good IMO
-- like a normal foreskin only with a bit of a "notch". Most of his
glans is covered. The pediatric urologist had hoped not to cut so far,
but he tried 2 times and there were so many skin adhesions he could
not retract the fireskin so he had to try a 3rd time and make the incision
longer. If he had been able to make the usual sized dorsal slit I think
Richard would have looked untouched, as even now you can hardly notice
it. The pediatric urologist mentioned that the foreskin must be cut
evenly on both sides, and that there is a technique to doing it right,
so that there will not be any tearing or bleeding of the incision later.
I did learn that very frequently boys are re-circed because the
pediatrician or ob/gyn does it in the hospital and they are not surgeons
and often do not do a good job. I talked to a few moms in the waiting
room who were taking their sons in to be re-circed due to ragged or
uneven circing. This is usually done under general anesthetic. My advise
for anyone having surgery done on a child's genitals, including circumcision,
is to have it done by a pediatric urologist. My insurance would only
have covered circing by my ob/gyn, if we'd had it done, so that might
be a problem for many people as well. The insurance companies maybe
don't want to pay for a specialist to do it.
I feel the same way about the circumcision wars. They are ridiculous.
Two people emailed me, berating me for having it done! As if they were
there! I mean, I had been worrying about it since he was born and tried
gently stretching (not pulling it off the glans just stretching the
bottlenose part). It was no use as the bottlenose part was loaded with
adhesions. The doctor made a small incision then a bigger one then
on the third try a bigger one. Each time he tried to retract but there
were so many adhesions that he had to do a bigger dorsal slit than
usual. So a bit of the glans is exposed, as opposed to no glans exposed.
But it cosmetically look good and Richard is a lot more comfortable
and I think he got the best treatment available.
Anyway, the doctor is a pediatric urologist named Dr. Julian Wan.
He works at Childrens Hospital in Buffalo for their urology department.
I am not at work now but will get you the phone number tomorrow ( or
if I forget remind me). I don't know if he has anything written down
or not, but it was clear that there is a technique to the dorsal slit.
Also, from talking to moms in the waiting room I get the impression
that a lot of circumcisions are sloppily done and have to be redone.