DORSAL SLIT RECOMMENDATION

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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.