Prepuce in boys and adolescents: What, when, and how?
Authors: Dobanovacki Dusanka , Lucic-Prostran Biljana , Sarac Dragan , Antic Jelena , Petkovic Mirjana , Lakic Tanja 
Published: July 2012

Introduction. The prepuce envelops the glans as a variant of a mucocutaneous
tissue presenting with a lot of functions, the most important of them being
to protect the infant?s glans from feces and ammonia in diapers, to protect
the glans from abrasions and trauma throughout life, and to provide
sufficient skin in erection. Circumcision was recognized as a method of
solving foreskin problems a long time before Christ. Practicing male
circumcision in history was customary several thousand years ago and has
spread worldwide. Today it depends on races, and it is often an initiation
ceremony near the age of puberty. In everyday practice in pediatric urology
outpatient department the foreskin problems have been noticed as a phimosis
in 9.91% cases and prepuce adhesions in 3.98%. Congenital anomalies are
present in different numbers. Other problems, such as paraphimosis,
balanoposthitis, are recorded as accidental cases. Over-all prepuce pathology
can be observed in 12%-25% of patients. The article presents a review of
foreskin conditions, clinical manifestation, therapy and arguments for
patient?s benefits. Clinical presentation. The term phimosis describes a
foreskin that is unable to retract. It is necessary to distinguish normal
anatomic situation in neonate and infantile period, when prepuce has not been
separated yet from true pathologic phimosis due to fibrosis and sclerosis. Up
to six years of age the tip of the prepuce is elastic and might be retracted
by gentle manipulations. In cases when the foreskin is trapped behind the
glans penis and cannot be pulled back to normal position, paraphimosis is
present and can be treated as a medical emergency by manual manipulation, or
by dorsal slit (incision). Many studies have demonstrated that frequency of
urinary tract infection increases in uncircumcised males and that is a reason
for routine circumcision. The others are against routine circumcision. The
contraindications are newborns, especially prematurely born, and congenital
penile anomalies. Condition in which the frenulum of penis is short with
consequent restriction of movement of the prepuce can be easily treated by
frenulotomy. Hooded prepuce is a condition of incomplete circumferential
formation of foreskin with a dorsal component present and ventral component
absent. In cases without any penile anomalies this is only a cosmetically
unattractive appearance and could be corrected by circumcision. Infection of
the foreskin due to bacterial colonization could be both prevented and
treated easily. However, an infection due to peno-preputial incisions in
adolescent age is serious and has to be cured promptly. Conclusion. As a part
of external genitalia, the foreskin has a lot of functions. Despite its
natural role many advocates routine circumcision due to problematic condition
that can develop. Routine circumcision is not generally recommended. Improved
education for physicians and parents with regard to the foreskin development
and management is required.