From our previous videos and blogs, you know our views on neonatal circumcision. We do not believe that circumcision is medically necessary for every male; with proper hygienic care, you can benefit from the advantages of circumcision. However, if your child is to be circumcised one day due to reasons such as religion, tradition, or social pressure, we think the easiest, healthiest, and safest method is during the neonatal period. Indeed, people who have given birth outside the hospital we work with contact us within the first month to bring their babies for neonatal circumcision. We first conduct examinations and, if suitable, quickly organize their circumcisions.

I want to address a common situation we encounter during these pre-circumcision examinations. In this part of the pediatric surgeon’s logbook, I will explain penile torsion.

During the pre-circumcision examination, we can detect many previously unnoticed problems. Nowadays, parents are highly conscious and can question any problem. We meticulously examine and share any issues we observe with the families to minimize the risk of possible complications.

To get to the point, we noticed that a significant number of babies have a spiral-shaped torsion of varying degrees, almost always counterclockwise, along the line running from the middle of the scrotum to the tip of the penis. Often associated with conditions we call hypospadias and chordee, this pathology can sometimes be found alone. I want to emphasize that penile curvature is a different issue; here, I am talking about torsion of the penis.

Some studies mention that the frequency of isolated penile torsion is unknown, while others describe it as a rare anomaly, and some characterize it as common. Reported frequencies of penile torsion range from 1.7% to 27%, but torsion greater than 90 degrees is reported at only 0.7%.

We conducted our own study to investigate the frequency of this problem. When we examined 1,000 healthy babies with no additional problems before circumcision, we found that 20% had torsion. A very high rate—imagine, one in five babies has torsion. Among these 200 babies, we found torsion greater than 45 degrees in 43 babies, and in very few, it was more than 90 degrees.

There are some theories about why this occurs, but I won’t bore you with them here.

So, is this really a problem if it’s so common? Does it cause complaints? In most cases, it doesn’t cause any problems. However, parents want the cosmetic defect corrected. One study mentioned that it could cause a disruption in urine flow in about 60% of cases.

In a study conducted on adults, over 10,000 patients were examined, and it was found that only 2% were bothered by this condition.

It seems it doesn’t cause much of a problem. What do we do?

In our study, we circumcised all 157 babies with low-degree torsion below 45 degrees. For babies with high-degree torsion, we provided sufficient information to their families and recommended correction with circumcision under general anesthesia after six months of age.

In follow-up examinations on the seventh day after surgery, there were no complications, and the parents were satisfied with the results. When we contacted the parents about 1.5 years later, we learned that they were happy with the cosmetic appearance. We presented these findings at our National Pediatric Surgery Congress and published them in an international journal.

To summarize, low-degree torsions are not significant, while high-degree ones can be corrected during circumcision under general anesthesia, mainly for aesthetic reasons.

That’s the end of another log. If you want to watch what I’ve explained, please click on my YouTube channel. Stay happy.

Prof. Dr. Egemen Eroğlu
April 2024