[ ARC forum 2 ]

Review

Written by Paul B. at 31 Jul 2003 15:25:14:

As an answer to: More info about my son written by wendy at 31 Jul 2003 07:36:06:

A few brief comments here. Hmm, well, that was the proposition ...

The existence of "scar" tissue in itself is not an indication that stretching will not be effective - this is readily dealt with using a fluorinated steroid. Hydrocortisone is not such a steroid, and my general impression is that you would be totally wasting your time to try it. Betamethasone or Triamcinolone would appear to be the preparations of choice, and should be in the ointment form. My instructions for adults should give a reasonable indication of the process.

Skin problems such as this should never be taken to urologists, unless you know the urologist has particular competence in the matters of both foreskin dermatology and surgery. Your description of the "flaking" skin and the transfer to/ from the thighs, is fairly conclusive indication of either a fungal infection, or on its own, the healing phase of a bacterial infection. Generally speaking however, a bacterial infection alone is improbable and would not not spread to the thighs, and it seems more likely that if there is, it was caused by a fungal infection. You don't seem to make it clear whether this has actually been treated at this point.

Streptococcal infection is admittedly a possibility and would usually coincide with a predilection to sore throats and if demonstrated on a swab/ culture, the treatment is the same. It would be unlikely however, to lead to constriction.

If surgery was the only option and you wish to preserve his foreskin function, you need to find (but may be a tall order in America) a urologist competent in preputioplasty - procedures which enlarge the opening with no loss of skin. Since he is pre-pubertal and as the other posters have indicated, you do not immediately need full retraction, a combined management - surgical enlargement of the opening followed by stretching and the use of a steroid, would be practical. Presuming of course, that you have the necessary rapport with the son.

You do seem to have a significant problem with the spraying. This is generally worse if you attempt to retract the foreskin whilst peeing - it is generally minimised by either full retraction where that is possible, or no retraction - allowing the "acroposthion" - the "nipple" of foreskin in front of the glans - to form fully as a "nozzle".

The "ballooning" is not in itself harmful as long as he is not significantly slow to pee and it does not cause discomfort. The foreskin will balloon with even minor restriction because the foreskin is easily inflated.

And it should be mentioned that there is no immediate reason why this condition should not be treated identically with meatal stenosis - the narrowing of the opening in the glans itself, commonly caused by circumcision. The treatment is (may need to be repeated) simple dilatation under anaesthetic. The anaesthetic itself can be easily administered - by someone competent in its use - using EmlaŽ cream, and dilators passed to simply - enlarge the opening. It is not at all unreasonable that this could be performed painlessly on successive occasions. It would however require that treatment for any fungal problem be started in advance.

As to diabetes, it is totally irrelevant to childhood diabetes, as to whether any relative has this - it is the age-onset form that is heritable. Negative urine tests are also irrelevant, the diagnosis is made on blood tests (possibly "finger-prick").


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