Welcome to the Pediatric Surgeon’s Journal.
Thank you for asking me questions and writing comments. Your questions continue to determine our route. In this blog, I will write about the answer to a question that has been asked me a lot in my clinical life. Of course, based on hand-held data.
Does treatment of mucosal adhesions need an operation?
A mother walks in my examination room at the polyclinic, a small child in her arms or in a stroller. The mother’s eyes are wide open.
“Welcome. What happened?” I ask.
“ I cannot fully see the circumference of the penis’s head. He had to have surgery. “ she says.
While continuing to take the story, I can feel the resentment in her eyes if I have done newborn circumcision before, and dissatisfaction if another colleague has done it, and some anger.
I lay my little patient on the examination bed, under the mother’s hurt or anxious gaze. My nurse opens his diaper, I see the mucous part of the skin on her penis adhering to the head of the penis, that mushroom-shaped appearance disappears.
If you think that I am telling you a made up story, you are wrong. It’s a situation that I’ve lived thousands of times. During my clinical practice, I have dealt with major surgeries so much… but in real life such minor problems are more common, and we may not have thought about it at all. I research literature and I realize that there is not much caring in academic life, but I am faced with this problem in clinical life …
We designed a study. In the six-month period, I saw again all the children who came to the pediatric outpatient clinic to my pediatrician friends for other reasons, whom I had previously performed neonatal circumcision. 630 children in total, with an average of 16 months. Mucosal adhesions were present in 97 of them, ie 15%. When I grouped it by age, we saw that this rate was 20% under 1 year old, while this rate was only 1% above 3 years old. You can find the link of our article by clicking here. These findings also support the knowledge that mucosal adhesions will open spontaneously as the baby begins to walk, adipose tissue decreases, the penis begin to emerge, and the gland is freed.
We tell the parents how to wait by slowly explaining to them. But in real life, that’s not how it goes. Mothers can insist on solving the problem immediately. In this case, we first apply EMLA cream, wait a while and open it easily. Eyes full of resentment and anxiety immediately begin to soften. The same line always sounds:
“Wow was that all? I thought he was going to have surgery. “
Normally, the foreskin of all male babies is attached to the glans, that is, to the head of the penis. This adhesion opens like 3-4 years of age in the physiological process. Since uncircumcised penis care is not known in our country, sometimes this process can take a little longer.
After performing newborn circumcision, we apply petroleum jelly until the mucosa and glans skin becomes keratin. But the tissue heals so quickly… it can still stick together.
Here is the trick. We see all newborns circumcised again after about 10 days. Adhesions that occur right after the circumcision, including the incision area, should be treated immediately. Otherwise, the adhesion gets stronger and becomes skin and skin bridges may form. This rate was 0.3% in our study. Skin bridges do not pass by themselves, surgery is required. Of course, it is necessary to differentiate secondary phimosis, which happens if the incision area narrows and heals on the head of the penis due to reasons such as redundant foreskin or buried penis, Therefore, it is very important to come to the control after circumcision.
Let’s put it all together.
After newborn circumcision, definitely go to your control. Do not overlook the early problems that may occur after surgery.
Do not be afraid of the simple mucosal adhesions that occur later due to diaper rash. It opens spontaneously. It cannot be opened or you come if you want an early solution, we can easily open it in the polyclinic.
We have come to the end of another course. I have said before that I want you to be captain. I see that you prefer to send me direct messages on Instagram. You can determine our route by e-mail or the comments you will make below.
If you want, you can watch our video on youtube. Please follow su on Instagram. 
Stay happy.
Prof. Dr. Egemen Eroğlu
January, 2020