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Is Circumcision The Right Solution For Difficult Urination?

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Posted on Thu, 25 Sep 2014
Question: My husband a very active, healthy, non -circumcised 72 year old, had to have a small portion of the tip of the penis and a small portion of foreskin removed due to a film of white growthlike material growing(over a long period of time) over the head of the penis making it difficult to urinate. He objected to a full circumcision. We have researched and questioned other professionals extensively and do not believe full circumcision is best at his age. The surgeon/urologist said he removed or stripped off a lot of fibrous like fiber that had basically prevented the pushing back of the foreskin for all of my husband's life because he (urologist) thought the foreskin needed to be retractable. This seemed a bit radical to us but it was done during surgery. Since the procedure, done in hospital by this urologist, my husband still has a tiny area of redness that has not cleared up to normal pink color and an almost constant itching in the area under the foreskin on that side of the "head" of the foreskin that is left after the procedure. The foreskin has now grown back to the shaft of the penis as it always was (only about 1/4 cm is visibly red)so it is not possible to see how large an area this might have been. All swelling of tissue has gradually gone back to a normal appearance except for a tiny amount of swelling in this same area of the foreskin. We wondered if it is possible that the surgeon utilized the wrong type of suture material when "stitching" up the cut foreskin. He said it was a dissolving type of material but it seems almost as though the underlying stitched area has an irritant concealed there. Can this be viewed by an x-ray or some type of ultrasound scan ? Is there a gentler, more delicate procedure that can be done by some other specialist to that tiny bit of foreskin without more of a circumcision-like procedure? It has been several months and the urologist just wants to do more of a full circumcision procedure. There is no pain in the entire area of the penis nor in the entire shaft or foreskin but there is an annoying frequent itching/ burning that is almost as though something like a thread or piece of foreign material is caught there. What type of specialist can we consult to determine what should be done. As this must have been a very traumatic tissue removal is it possible we need to give it much longer to heal? The rest of the area visible has slowly, over several months, returned to a healthy pink color but it has taken a long time.
doctor
Answered by Dr. Deepika Patil (2 hours later)
Brief Answer:
could be due to reminant stitch

Detailed Answer:
Hi Mam,

Welcome to HealthcareMagic .

I read your query and understand your concern . Usually circumcision is not of much use at this age. You said your doctor removed fibrous thing. Yes it is necessary to remove all fibers to make foreskin retractable because foreskin should always be able to retract completely. Otherwise it cause infection and pain and difficulty in urination.

To see how much area is reddened you may gentally retract the foreskin and see. Also after that place it back to its normal position.

After reading your query I feel some stitch have not dissolved and causing irritation and formed granuloma. This is causing itching and not healing. This can't be seen on x ray. By proper clincal examination it can be made out by touching the area. If needed by ultrasound it may be confirmed.

For this problem a expert urologist(urosurgeron) is the specialist who will deal . For genital problems there is no higher speciality available more then urologist.

If stitch is there then that may be removed without need for circumcision. If still stitch is there then unless it is removed the area won't heal. Usually penile lesions take longer time to heal.

I suggest you to discuss this with your urologist and discuss about stitch granuloma. The time taken for sutures to dissolve is different from person to person .

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Deepika Patil (45 hours later)
Thank You!
To clarify: The foreskin can not be retracted at all but appears loose along the shaft as it always had in the past. Only the top 1/4 inch around the opening appears to be attached to the penis The urologist would not allow my husband to push back the foreskin right after surgery because he said it would probably cause excessive bleeding. 7 day Follow up from surgery he said the same and the 2nd followup the skin was already fairly attached to the penis. As he stitched all around the opening of the foreskin it seems as though he simply stitched it too tight. (The stitched area is underneath the end of the foreskin and not at all visible.)
This urologist only wants to do more circumcision or partial circumcision. Is it possible after this amount of time that my husband can gradually push the skin back so that it will work loose and push back? He has normal erections with no pain and no pain other that that constant itching/burning in the one area .
Should we request ultra sound to determine if stitches remain?
doctor
Answered by Dr. Deepika Patil (3 hours later)
Brief Answer:
not easy to pull it back

Detailed Answer:
Hi Mam,

Since from so many days your husband as not pulled the skin back and you say 1/4 th inch is attached I suggest you not to try yourself to pull it back. This may cause bleeding or pain. I suggest you to get it done by your doctor. It is unlikely that after so many days to easily pull back the skin. It might have been adhered there. With application of local anaesthetic gel gently doctor may try it. It may come smoothly and later can be done in home without need of gel.

If your doctor is not sure stitch is remaining after examining then better to request for ultrasound to find out the remnant stitch and later removal. Usually when we touch the area we can make out inside stitch is there or not as these are superficial stitches.

Don't worry about tight stitches . Usually when tight stitches are put that will cause swelling of the penis head and shaft. That is alarming sign and no doctor miss it to diagnose and rectify .

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Deepika Patil (2 days later)
We were wondering if you could recommend anything to help with the itching/burning in the area of the foreskin to help it heal faster. Is there anything natural or herbal that we could use to promote healing.
Also if these were not the natural type of stitches that dissolve on their own will they eventually breakdown and dissolve anyway?
Could a dermatologist be able to gently remove the stitching or must my husband undergo local anesthesia and have more foreskin cut off by the urologist/surgeon? We want no more trauma to his system.
Thank You!
doctor
Answered by Dr. Deepika Patil (8 hours later)
Brief Answer:
may try mupirocin

Detailed Answer:
Hi Mam,

For the itching area you may apply mupirocin after consulting your doctor. This will reduce inflammation and itching.

In herbel medicine you get combination of calendula,lemon XXXXXXX vulgaris etc. This is proved to reduce itching and burning sensation. But none of the ointments are proved to fasten the healing. Once inflammation subscide healing occur by itself. Keep the area clean .

Those are naturally dissolving stitches but some may have reacted with your husband body and caused inflammation. Since it has reacted it is better to remove it for faster healing. It may dissolve but take more time and it won't heal untill stitch is gone. Non dissolving stitches won't dissolve and remain forever in body unless removed.

If your dermatologist is experienced or a surgeon may remove it and there is no need to cut foreskin . Where stitch is there that area may be opened and stith removed.

Stitches are classified as absorbable (dissolve) and non absorbable(dont dissolve).

Hope I have answered your query . If any further queries are there I would love to help.

Regards
Dr.Deepika Patil
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Deepika Patil

General Surgeon

Practicing since :2008

Answered : 745 Questions

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Is Circumcision The Right Solution For Difficult Urination?

Brief Answer: could be due to reminant stitch Detailed Answer: Hi Mam, Welcome to HealthcareMagic . I read your query and understand your concern . Usually circumcision is not of much use at this age. You said your doctor removed fibrous thing. Yes it is necessary to remove all fibers to make foreskin retractable because foreskin should always be able to retract completely. Otherwise it cause infection and pain and difficulty in urination. To see how much area is reddened you may gentally retract the foreskin and see. Also after that place it back to its normal position. After reading your query I feel some stitch have not dissolved and causing irritation and formed granuloma. This is causing itching and not healing. This can't be seen on x ray. By proper clincal examination it can be made out by touching the area. If needed by ultrasound it may be confirmed. For this problem a expert urologist(urosurgeron) is the specialist who will deal . For genital problems there is no higher speciality available more then urologist. If stitch is there then that may be removed without need for circumcision. If still stitch is there then unless it is removed the area won't heal. Usually penile lesions take longer time to heal. I suggest you to discuss this with your urologist and discuss about stitch granuloma. The time taken for sutures to dissolve is different from person to person . Hope I have answered your query . If any further queries are there I would love to help. Regards Dr.Deepika Patil