Outpatient management of phimosis following newborn circumcision

Purpose: We reviewed our experience in treating patients with a trapped penis due to phimosis following newborn circumcision. The outcome of treatment of this condition at the outpatient clinic was examined. Possible etiological factors leading to this complication were determined. Methods: A total of 521 pediatric patients underwent Gomco circumcision while under local anesthesia at our outpatient clinic between 1994 and 1999. Phimosis was noted in 15 patients (2.9%), and an additional 13 patients were referred to our clinic with phimosis after undergoing circumcision elsewhere. These 28 patients underwent treatment for the phimosis at the outpatient clinic. The phimotic ring was manually dilated with a fine hemostat. Careful traction with sterile gauze was then used to reduce the phimotic band below the glans penis. No evidence of glans ischemia was noted. Mild edema of the pericoronal skin collar was common. Cases referred after age 6 months or those weighing more than 14 pounds were treated as an elective outpatient surgical procedure. Results: Three patients had recurrence of the phimosis. These cases were managed with manual retraction of the prepuce at the clinic. At 1 month followup 27 patients had resolution of the phimosis. One infant was lost to followup. Factors contributing to development of phimosis after newborn circumcision were reviewed. Ten of the patients had obvious poor penile skin attachment with concealment of the penis even after resolution of the phimosis. Phimosis occurred more frequently in older patients undergoing circumcision-15 patients were older than I month at circumcision. Mean body weight of the latter group at circumcision was 12 pounds. Conclusions: Phimosis with a trapped penis is an infrequent but important complication of circumcision. This condition is more likely to occur in older infants and those with poor attachment of the penile skin to the shaft. Early recognition allows outpatient treatment with excellent results, avoiding operative intervention with general anesthesia.