किर्कुम्किसिओन एंड phimosis

http://www.afrjpaedsurg.org/article.asp?issn=0189-6725;year=2008;volume=5;issue=1;spage=32;epage=36;aulast=Bhattacharjee

my boy was circumcised on 01.06.2009 at guwahati by Doctor M.I Khan mobile no : 9435044971. he has completed almost one lac cases during the last ten years of practice. he said phimosis is a common problem not understoood by almost 90 per cent of all people. because of this marital life of many people have been destroyed. lots of people are diviroced. and lots of males are not marriyng because of this medical p[roblem . this can be easily corrected by plastic surgery. he has done thousands of such cases successfully.

Jews and Muslims are getting the benifit without knowing the name of the disease when they circumcise their child according to their religion.

Most paediatric urologists recommend circumcision for acquired phimosis, paraphimosis, recurrent balanitis and in boys with recurrent urinary tract infections. [5] However, phimosis itself is a controversial diagnosis. In common usage it implies any condition where the foreskin cannot be retracted. But most infants are born with a foreskin that does not retract and it may not do so until after puberty- it is a normal physiology and not phimosis. Spontaneous full retractability occurs in 90% of the boys by 16 years and in 99% of males by 18 years of age. [24] The parents should be instructed against repeated forcefully retraction of the immature foreskin for "cleaning" of smegma as it would invite fibrosis and development of "true" phimosis or preputial stenosis. The production of smegma helps in natural separation of glans from the foreskin as the child matures.

Acquired phimosis is usually due to poor penile hygiene. Avoidance of external irritants (chemicals contained in bubble bath to name one) and regular cleaning of the accumulated dirt and urine under the foreskin later on in childhood will definitely prevent recurrent balanitis, and /or tearing of the delicate prepucial opening, thereby preventing acquired phimosis. [4] Sometimes generalized edema may result in non-retractile prepuce; hence general state of health should be assessed before a diagnosis of phimosis is made and circumcision is considered.

Rickwood et al. [14],[25] defined phimosis as a tight non-retractile prepuce caused by balanitis xerotica obliterans (BXO), characterized by a whitish hardened sclerotic skin at the tip of the prepuce. Many doctors in UK are often not trained to distinguish between pathological phimosis and the developmental tightness of the prepuce, resulting in misdiagnosis; [26],[27],[28],[29] the condition in USA is probably much worse. Rickwood et al. [14],[25],[30] noted that as a result of this over diagnosis, a number of circumcisions performed in UK is 8 times more than actually indicated. [14] Circumcision is only recommended for confirmed cases of phimosis caused by BXO.

A recent study from Scotland suggests that the steady decrease in the circumcision rates are due the awareness that healthy non-retractile foreskin in children does not require circumcision. [31]

The need of circumcision following reduction of paraphimosis is debatable. A good perineal hygiene may be equally effective (as circumcision) in reducing the incidence of urinary tract infection in baby boys. [4]

As the debate concerning the medical and ethical issues continues, the economic factors are beginning to limit the practice in some countries. In England and Canada, infant circumcision had been removed from the list of procedures available as public healthcare service; and in USA many private insurance companies have decided not to subsidize the cost of this procedure. [6]

According to Hutson [4] , it may be a matter of time before adult males who were circumcised in childhood begin legal action against their parents or their doctors for the so-called mutilation of their bodies without medical indications or permission.