© CIRP.org 1996-2024 | Please visit our sponsor and host: IntactiWiki.CHINESE MEDICAL JOURNAL 1991: Volume 104, Number 6: Pages 491-493.
Report of 512 cases
By He Ying* and Zhou Xiu-hua**
Changzheng Hospital
Second Military Medical College
Shanghai 200003
Five hundred and twelve boys, aged from 5 months to 12 years, with phimosis were treated by application of a specially designed balloon catheter (patented). 1% dicaine topical anesthesia was used. 3-6 months follow-up showed that all patients were cured. The procedure is simple, safe and much less traumatizing than the conventional circumcision. The mechanisms of balloon dilation, the age-specificity and the anesthesia were [sic] discussed.
Phimosis is not uncommon in young boys,[1] and surgical circumcision is usually advised.[2] Many of them have consequent urinary tract infection, frequent micturition or bradyuria but their parents are reluctant to agree to surgery because of fear and other concerns. We therefore developed a non-surgical treatment with a balloon catheter designed for pediatric use (patented in China), which was first applied to a 4-year-old boy in September 1987. Since then we have treated 512 patients aged from 5 months to 12 years at Changzheng Hospital, with satisfactory results as those of conventional methods. We report herein our clinical experience in 512 male children and discuss the mechanisms of balloon dilation, the age-specificity, the anesthesia and the cautions.
APPLIANCE. The balloon dilation technique for treating phimosis in boys includes a balloon catheter, an inflator, a valve clip and two curved retractors, which are all made of disposable plastics.
ANESTHESIA. It was given topically with 1% of dicaine.
CRITERIA OF DIAGNOSIS. Balloon dilation treatment is indicated for boy patients with a constricted preputial orifice impeding retraction of the prepuce over the glans penis and/or a history of either urinary tract infection, frequent micturition or bradyuria due to phimosis before the age of three years.
EVALUATION OF CURATIVE EFFECT. Success. Subsidence of edema of prepuce in 2 weeks and free retraction of prepuce over the coronary sulcus. Failure. The tip of the prepuce remains constricted and the prepuce cannot be retracted freely over the glans penis.
CLINICAL DATA. The age of the 512 phimotic boys ranged from 5 months to 12 years. Phimosis was severe in 397 (77.6%). 93 (18.2%) were under the age of 3 and all had complications. 65 (25.1%) of 259 between 4 to 7 years, and 29 of 160 aged from 8 to 12 years, had the same sufferings.
METHODS. The patient was kept in supine position. The preputial orifice was pulled slightly open with two curved retractors and 2-3 drops of 1% dicaine were dripped in After two minutes or so the balloon catheter was inserted in place, and the retractors removed. The balloon was inflated gradually, and the tip of the foreskin was adjusted to the middle part of the balloon, which was further inflated until the balloon waist disappeared or the preputial orifice was about 3-5mm greater than the maximal diameter of the glans penis. The balloon remained adequately inflated for 20-30 seconds by closing the valve clip. Dilation was repeated 2-3 times before the balloon was removed. By now the foreskin should be retractable freely over the coronary sulcus if there are no adhesions. Smegma was cleaned if any. The prepuce was drawn back and forth several times after dripping 2-3 drops of parogen in the orifice and finally restored to the original position. If any adhesions exist, blunt decollement should be made before dilation. Thereafter, the prepuce was retracted fully 2-3 times daily and cleaned with warm water. A few drops of parogen were applied to the prepuce once a day (Figs 1-3).
-------------------------------------------------------- | a photograph | a photograph | a photograph | | | | | | Before | During | After | | operation | operation | operation | | Fig 1 | Fig 2 | Fig 3 | --------------------------------------------------------
All patients over 4 years of age cooperated well during the treatment and no forced position was needed, indicating that anesthesia used in the process was effective and acceptable. Follow-up and correspondence investigations showed that 509 out of the 512 patients were completely cured after a single balloon dilation. Only three patients (0.06%) required 2-3 times of dilation, once every other week. The complicating urinary tract infection, frequent micturition or bradyuria in 187 children with phimosis, disappeared in in 169 (90.4% and alleviated in 18 (9.6%).
The following illustrative cases are noteworthy.
Case 1. An 11-year-old boy complained of tight phimosis, diabetes nervous bladder, uroschesis and ureterohydronephrosis, and had to use urinary catheter because of dribbling of urine and enuresis nocturna. He preferred balloon dilation to circumcision for fear of infection. As a result, the patient was freed from mechanical urethophraxis, frequent micturition and enuresis nocturna. Ureschesis and ureterohydronephrosis were significantly relieved.
Case 2. A 3-year-old boy with tight phimosis and persistent hematuria, had been admitted to hospital because of repeated urinary tract infections (five times in 2 years). The follow-up 14 months after balloon dilation showed he was cured.
MECHANISMS OF BALLOON DILATION. Generally, circumcision is accepted as the treatment of phimosis for penis hygiene and elimination of smegma bacilli, inflammation and other complications. It is also considered as an effective way of preventing carcinoma of the penis.[3] However, it is traumatic so that not few patients and their parents are often reluctant to accept this treatment. Knowing that balloon dilation is helpful in managing the constrictions of blood vessels, esophaguses, urinary tracts and ureters,[4-6] we have applied this method in treating phimosis in 512 boys since 1987. The prepuce of young boy (sic) is soft and free of fat and is extensible both anatomically and mechanically.[7] Besides, the procedure is simple and safe requiring no sophisticated skill and equipment. Even a junior physician can do it with brief training. It carries only a little discomfort and psychic stress to the patient. The success rate is as high as 99% according to our experience.
AGE SPECIFICITY FOR BALLOON DILATION. Almost every male infant or baby has congenital phimosis. However in most children the prepuce becomes spontaneously retractable with the growth and erection of the penis during the first two years of life. It has been reported that at 4 years of age phimosis occurrence is 32%. They are often brought to pediatricians for care of inflammation and infection, which occurred in 36.5% in our series. The preputial orifice often became thicker and a fibrous ring made the foreskin less elastic and extensible. Dilation by one attempt in such cases often resulted in failure. Our experience suggests that the optimum age for balloon dilation is 2-4 years.
ANESTHESIA. Balloon dilation is almost nontraumatic and time to accomplish the treatment is relatively short. In our practice, we used 1% dicaine topical anesthesia with satisfactory results in all cases. Almost every patient cooperated well, and no allergic reaction has been found so far.
* Department of Pediatrics
** Department of Nursing Care
CIRP Note: Non-retractile foreskin is the normal condition in pre-pubescent boys. It is not a disease and seldom, if ever, requires treatment. The treatment of this non-disease in young boys by these Chinese doctors reveal their ignorance of the normal development of retractile foreskin in boys. Nevertheless, balloon dilation of the prepuce is preferable to circumcision.
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