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Pitts D, Aponte-Colon D, Chalmers D. Resolution of post-circumcision penile adhesions in newborns. J Pediatr Urol 2022; 18:183.e1-183.e5. [PMID: 34980556 DOI: 10.1016/j.jpurol.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Penile adhesions are a common complication of neonatal circumcision and can cause significant distress to families. Although prior studies have suggested adhesions resolve with conservative measures, the information on the likelihood and time frame is not known. Alternatively, a lysis of adhesions (LOA) procedure can be performed in the office. The aim of the study was to determine the likelihood of spontaneous resolution with conservative measures at home. METHODS A retrospective review of patients with post circumcision penile adhesions that were referred to a pediatric urologist was conducted. Data regarding patient age, extent and severity of adhesions, chosen treatment modality (home-care with daily retraction versus LOA), improvement in subsequent visits, and final outcome of adhesions was obtained from chart review. Contingency tables, chi-square tests, or t-tests were used to assess statistical significance. RESULTS 429 patients were reviewed. The mean age was 28.2 months (range 1-152) and mean follow-up was 7.4 months (range 1-70). Adhesions were circumferential in 81% of patients and incomplete in 19%. Additionally, 64% of patients had adhesions that covered less than 50% of the glans penis, compared to adhesions that covered 50% or more in 36% of patients. After the initial visit, 66% of patients elected the home-care regimen, 89% of which were seen in follow-up visits. Only 36% of patients treated with the home-care regimen had completely or substantially resolved adhesions after a median of 6 months. Results showed a significant difference in success with home care depending on the circumferential extent of adhesions (p < 0.05), with patients whose adhesions covered less than 25% of the glans penis having the greatest likelihood of improvement. Effectiveness of home therapy also varied depending on the severity of adhesions (p < 0.05), with patients whose adhesions covered less than 50% of the glans having a higher chance of success. Most patients that initially chose the home-care regimen (65%) eventually elected to undergo LOA in the office. This study is limited by the retrospective nature, failure to control for potential confounders such as weight and the degree of participation at home, and the time frame after initiation of home therapy, which might have been insufficient for complete resolution of adhesions. DISCUSSION The conservative management of post-circumcision adhesions is not effective over a 6 month time frame, with the great majority of the patients eventually undergoing LOA. Physicians can classify the severity and extent of adhesions to predict what patients might have more success with conservative management. LOA might be better suited for patients with more severe adhesions.
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Affiliation(s)
- Daniel Pitts
- Maine Medical Center, 22 Bramhall St., Portland, 04102, ME, USA.
| | - Diana Aponte-Colon
- Tufts University School of Medicine, 145 Harrison Ave, Boston, 02111, MA, USA.
| | - David Chalmers
- Maine Medical Center, 22 Bramhall St., Portland, 04102, ME, USA.
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Blume-Peytavi U, Tan J, Tennstedt D, Boralevi F, Fabbrocini G, Torrelo A, Soares-Oliveira R, Haftek M, Rossi AB, Thouvenin MD, Mangold J, Galliano MF, Hernandez-Pigeon H, Aries MF, Rouvrais C, Bessou-Touya S, Duplan H, Castex-Rizzi N, Mengeaud V, Ferret PJ, Clouet E, Saint Aroman M, Carrasco C, Coutanceau C, Guiraud B, Boyal S, Herman A, Delga H, Biniek K, Dauskardt R. Fragility of epidermis in newborns, children and adolescents. J Eur Acad Dermatol Venereol 2016; 30 Suppl 4:3-56. [PMID: 27062556 DOI: 10.1111/jdv.13636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/10/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
Abstract
Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.
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Affiliation(s)
- U Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin, Berlin, Germany
| | - J Tan
- Department of Medicine, Faculty of Medicine, Schulich School of Medicine and Dentistry, Western University, Windsor campus, Windsor, ON, Canada.,Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - D Tennstedt
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - F Boralevi
- Pediatric Dermatology, Pellegrin Hospital, Bordeaux, France
| | - G Fabbrocini
- Department of Dermatology, University Hospital of Naples, Naples, Italy
| | - A Torrelo
- Pediatric Dermatology, Hospital del Niño Jesús, Madrid, Spain
| | | | - M Haftek
- University Lyon 1, Lyon, France.,University Lyon 1, EA4169, "Fundamental, clinical and therapeutic aspects of the skin barrier function", Lyon, France
| | - A B Rossi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Department of Dermatology, Toulouse University hospital, France
| | - M D Thouvenin
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - J Mangold
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - M F Galliano
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Hernandez-Pigeon
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - M F Aries
- Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Rouvrais
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Bessou-Touya
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Duplan
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - N Castex-Rizzi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - V Mengeaud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France
| | - P J Ferret
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | - E Clouet
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | | | - C Carrasco
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Coutanceau
- Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France
| | - B Guiraud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Boyal
- Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - A Herman
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - H Delga
- Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - K Biniek
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
| | - R Dauskardt
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
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