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

2. 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 )

3. 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

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

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

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

7. 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.

8. 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.

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

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

11. The more layers, the better

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

13. Thank you!
Urine good hands