The Exciting World of Pediatric Penile Surgery Benjamin Taylor, NP-C St. luke’s children’s urology

Quick to Complex Foreskin related issues Hypospadias Problems that may require a circumcision Balanitis Phimosis Penile torsion or chordee Problems post circumcision Penile skin bridge Buried penis Meatal stenosis Hypospadias DSD (Very complex. Requires it’s own discussion )

To circ??? Or not to circ??? Why people circumcise: Why people don’t circumcise: Culture Decrease infection risk Medical reason Culture Seems cruel No access

Phimosis and Balanitis Non-surgical treatments Surgical Antibiotics Betamethasone Retraction (careful!) Observation Circumcision

Penile torsion “twist” If mild, it may not need any repair. Recommended repair if more than 45 degrees typically.

Chordee “bend” Again, if mild, may not require any intervention. May be done pre or post circumcision, but always ends up circumcised.

Skin Bridge vs. Adhesions Adhesions = “stuck” Skin bridge = “grown together” Time Gentle retraction Manual retraction in the office (careful- tough to do well) Betamethasone Surgical correction Could cause discomfort with erections and/or hygiene concerns.

Meatal Stenosis Post circumcision Powerful stream Often diverted stream Thought to be caused by rubbing on diapers. Scar tissue. Correct it to avoid “pushing” to void and pelvic floor dysfunction.

Buried penis Terrible name. Minimal or poor attachments at the base of the penis. Large fat pad. Can cause adhesions and hygiene concerns.

Hypospadias 1 out of every 150 males Rate has increased in recent decades. Environmental concerns?? Progesterone usage??

The more layers, the better

Other considerations- Caudal block Vaseline Surgeons love it! Less bleeding. Less narcotics. Our best friend!

Thank you! Urine good hands