Dear PCP: Care of the circumcised penis

This post goes over common circumcision complications and how to prevent them.

These are the most common long-term complications of neonatal circumcision:

  1. Meatal Stenosis
  2. Soft penile adhesions
  3. Penile skin bridges
  4. Concealed penis

Meatal stenosis

A small urethral opening associated with a deflected urinary stream is commonly referred to as meatal stenosis. However, the meatal stenosis occurring after neonatal circumcision is not a “true stenosis”, as these children have a normal size urethra upon calibration despite having a visible small urethral meatus. 

A better term for the condition is meatal web. True meatal stenosis occurs mostly after hypospadias surgery.

Meatal webs occur in about 7% of patients after neonatal circumcision. Meatal webs are thought to originate from diaper irritation of the head of the penis and the urethral meatus mucosa. A “web” then develops to protect the delicate urethral meatus mucosa which can cause deflection of the urinary stream and a visible small urethral opening. Irritation in this area can also cause “scab crusting” of the urethral meatus with complete occlusion of the opening that is released with each urination, usually with some discomfort.

Meatal webs are not life-threatening and are not associated with serious problems like urinary tract infections, bladder obstruction or kidney damage. They are mostly a nuisance since the child is not able to void standing up without making a mess. If untreated the problem resolves itself by puberty, since we never see meatal membranes in post-pubertal boys.

Although not widely recognized, meatal webs can potentially be prevented by applying Vaseline to the tip of the penis and circumcision site with diaper changes for 6 months, as demonstrated in this study. The study also found fewer infections, bleeding and faster recovery in the group using Vaseline.

Soft penile adhesions, penile skin bridges, and concealed penis.

This post goes over soft penile adhesions and penile skin bridges in more detail.

A concealed penis occurs when the head of the penis telescopes inside the foreskin after a circumcision, with the circumcision line then contracting over the head of the penis. Children with “excessive” suprapubic fat pad that causes the penis to “hide” are susceptible to this complication.

The 3 moves to prevent the most common neonatal circumcision complications:

  1. Retract foreskin until  the entire corona is visibleSoft penile adhesions

  2. Clean with wipe around the corona

  3. Apply vaseline around circumcision, and head of the penis including the opening of the urethra.

Based on the study referenced above, I recommend doing these 3 steps with diaper changes for the first 6 months of life.

If the above was practiced by all families in the USA, close to 100,000 meatotomies (most of them under general anesthesia) could be avoided per year. A similar amount of lysis of post-circumcision adhesions, which again are mostly done under anesthesia, could also be avoided.  Meatotomies and lysis of penile adhesions can be done under topical anesthesia nevertheless.

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