• Clinical and Experimental Pediatrics
• /
• v.48 no.6
• /
• pp.594-598
• /
• 2005

Purpose : Phimosis is the inability to retract the foreskin of the penis over the glans of the penis. Even though phimosis is not pathogenic, the presence of phimosis is known to increase the risk of urinary tract infection in infancy. The use of topical steroids has been advocated as a safe and economical alternative to surgical intervention. The purpose of the study was to assess the effectiveness of topical steroids for the treatment of phimosis in young boys. Methods : A total of 53 boys with phimosis were divided into two groups to distinguish between the efficacy of low-potency topical steroid(group 1, 27 cases) and of high-potency topical steroid (group 2, 26 cases). Results : The success rate increased in the process of time. After 6 weeks, the success rate was 21 cases in group 1 and 22 cases in group 2. There was no significant differences in treatment outcomes between the two groups. The age of the boys, the appearance of prepuce prior to treatment, and the presence of previous symptoms, including symptoms of UTI, and ballooning of the prepuce at micturation had no significant difference on treatment outcomes. Conclusion : Topical steroid was effective in treatment of phimosis in boys younger than 4 years old. Although treatment outcomes between low- and high-potency topical steroids were not significantly different, those treated with a high-potency steroid cream showed more fast improvement. Further studies are necessary to assess systemic side effects of steroid treatment, duration of treatment and prevention of genitourinary tract infection in male infants.

• Journal of Veterinary Clinics
• /
• v.30 no.2
• /
• pp.123-126
• /
• 2013

A 3-month-old male domestic shorthair cat was presented for evaluation of stranguria and hematuria and a 4-year-old male domestic shorthair cat was presented for evaluation of stranguria. For cat 1, a swollen prepuce, erythematous preputial orifice, and urine pooling from the preputial orifice were noted. The preputial orifice was a pinpoint opening and penis was not extruded from the prepuce. For cat 2, a necrotic skin around the preputial orifice, small preputial orifice, and severe urine pooling from the preputial orifice were noted. The round-shaped resection of the tip of the prepuce was performed to increase the diameter of the preputial orifice and remove erythematous fragile skin or a necrotic skin around the preputial orifice and the edematous, redundant preputial mucosa in these 2 cats. The preputial mucosa was then apposed to the ipsilateral incised skin edge. There was no recurrence of clinical signs over 22- and 24-month follow-up period, respectively. The round-shaped resection technique provided adequate enlargement of the preputial orifice to allow extrusion of penis in these 2 cats with a phimosis. This technique could be helpful in cases with skin and mucosa necrosis around the preputial orifice that require round-shaped resection.

• The Korean Journal of Pain
• /
• v.28 no.4
• /
• pp.244-253
• /
• 2015

Background: Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods: We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results: A total of 301 children with a mean age of $7.56{\pm}2.61$ years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions: Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results.

• Childhood Kidney Diseases
• /
• v.13 no.2
• /
• pp.207-214
• /
• 2009

Purpose : To evaluate the cause of asymptomatic bacteriuria (AB) or aseptic pyuria (AP) on physiologic phimosis and to evaluate the effect of topical steroid therapy and preputial hygiene on the resolution of AB and AP. Methods : Ninety uncircumcised boys (age 1-72 month, median 16 month) with AB or AP were examined for physiologic phimosis and allocated by the preputial retractibility into the non-retractile group (n=59) or the retractile group (n=31). Topical steroid therapy [topical application of hydrocortisone (0.1%) cream with physiotherapy] were prescribed (three times a day) and the method of preputial hygiene (gentle retraction of prepuce and water cleansing) was instructed to the non-retractile group. After 2-4 weeks, the preputial retractibility was reevaluated and urine examination was repeated. To the retractile group, only the method of preputial hygiene was instructed and urine examination was repeated two weeks later. Results : Among 90 boys with AB and AP, 65.6% (59/90) had the nonretractile prepuces and nonperformed preputial hygiene. In the nonretractile group, the prepuces became retractile in 81.4% (48/59) after topical steroid therapy. Among boys (n=48) whose prepuces became retractile after topical steroid therapy, AB or AP resolved in 77.1%, decreased in 18.7% and persisted in 4.2%, which were significantly different to 18.2%, 2.37%, 54.5% in boys (n=11) whose prepuces were persistently nonretractile (P=0.0114). In the retractile group (n=31), 65.2% was compliant to preputial hygiene. In boys (n=23) who were compliant to preputial hygiene, AB or AP resolved in 65.2%, decreased in 26.0% and persisted in 8.2%, which were significantly different to 12.5%, 50%, 37.5% in boys (n=8) who were not compliant (P=0.0457). Conclusion : Physiologic phimosis was an important cause of AB or AP. Simple topical steroid therapy on the nonretractile prepuces and good preputial hygiene could improve AB or AP.

• Childhood Kidney Diseases
• /
• v.9 no.1
• /
• pp.46-55
• /
• 2005

Purpose : Recurrent urinary tract Infection(UTI) in primary vesicoureteral reflux(VUR) may lead to serious renal scarring, a major cause of childhood hypertension and end-stage renal disease. To prevent recurrent UTI, low-dose long--term antibiotic prophylaxis has been recommended. However, recurrent UTI still develops during antibiotic prophylaxis, the efficacy of which is now being disputed. The emergence of resistant bacteria has also raised concerns. To evaluate the effect of antibiotic prophylaxis, we investigated recurrent UTI during prophylactic antibiotic use in children with primary VUR Materials : The incidence and risk factors of recurrent UTI were retrospectively evaluated in ninety-one children with primary VUR on trimethoprim- sulfamethoxazole(TMP/SMX) prophylafis during the year following their index febri]e UTI. Results : Recurrent UTI occurred in 31.9%(29/91) children and comprised 0.32 episodes/patient year. Febrile UTI was 0.26 episode/patient year and afebrile UTI was 0.07 episodes/patient year. The recurrent rate of UTI in male patients with phimosis was 37.2%(19/51), which was significantly higher than in males without phimosis 0%(0/5)(P=0.025). In the logistic regression analysis for recurrent UTI, renal scar was the significant risk factor for recurrent UTI [RR 3.8(95% CI 1.0-14.1) P=0.04]. For other well-known risk factors such as sex, age, degree of VUR, APN, and voiding dysfunction, the differences were not significant. Conclusion : TMP/SMX prophylaxis did not prevent recurrent UTI in children with primary VUR. Phimosis and renal scars were the risk factors for recurrent UTI but the grade of primary VUR was not. In VUR without phlmosis and renal scar, a randomized controlled study without antibiotic prophylaxis is required. (J Korean Soc Pediatr Nephrol 2005;9:46-55)

• Archives of Plastic Surgery
• /
• v.40 no.3
• /
• pp.247-250
• /
• 2013

Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.

• Childhood Kidney Diseases
• /
• v.19 no.2
• /
• pp.56-64
• /
• 2015

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. $^{99m}Tc$-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

• The Journal of Korean Society for School & Community Health Education
• /
• v.1 no.1
• /
• pp.95-106
• /
• 2000

The purpose of this study was to be of use for the preparation of more desirable sex education system at elementary school, by making content analysis of the current textbooks related to sex education and surveying what opinions the persons concerned had about it. The purpose of this study were as follows; Elementary school textbooks were analyzed to find out what kind of sex education was included in them. And questionnaires on how to improve school sex education content were prepared, by which 207 male and female teachers were surveyed in the city of Paju and Koyang, Kyonggi province. The conclusions were as follows; 1. Content Analysis of Textbook Sex Education The content related to sex education was relatively much included in textbooks of the right life, morality and physical education. Although morality was a subject to be instructed for the third-grade students or older, elementary school students virtually received sex education from the first grade, as the right life and the joyful life were a subject for the lower-grade students, and this met the goal of sex education or the need of the times. However, sex education content leaned heavily toward family, family life or parental love. There was no mutual complement among subjects, and no link among grades, either. 2. Teacher Opinion on Sex Education Content for Each Grade When the subjects were asked about if sex education content was appropriate for each grade, they answered 20 items should be more emphasized and 6 items might be left out. And there were 6 items regarded by them as one that should be rearranged in consideration of grade. 3. The Ideal Opinion of Sex Education Content The following model could be recommended for elementary school sex education, which was designed to meet the objectives of school sex education as much as possible and to offer a systematic link among grades, based on the findings by textbook analysis and Questionnaire survey, and on elementary school sex education materials recommended by the Ministry of Education: The content selected for the first grade of elementary school was my body, cleanness of genitals, male-female cooperation, and family cooperation. For the second grade, the selected content was male-female physical difference, male female psychological difference, parental and I(origin of a birth). For the third grade, the selected things were important a body(cleanness of genitals), birth of a life, and male-female comprehension and cooperation. For the fourth grade, the selected things were physical development, management of genitals, physiology and management of menstruation, propagation and growth of organism, concern for the other sex, comprehension of and cooperation with the other sex, and prevention of sexual violence. Four the fifth grade, the selected things were secondary sex characteristic, physiology and management of menstruation, operation for phimosis, understanding of seminal emission, structure and function of the genital organs, birth and growth of a baby, television/sex information, and mass communications/sex information. For the sixth grade, the selected things were secondary sex characteristic, understanding of seminal emission, male-female cooperation, male and female role, male-female manners, mass communications/sex information, family and family life. Finally, what should be taught in sex education must be studied constantly, as it should be revised or supplemented periodically, according to student's sexual maturity or social, cultural changes.

• Biomedical Science Letters
• /
• v.4 no.2
• /
• pp.143-151
• /
• 1998

To study the incidence and epidemiological factors of uterine cervical cancer in medical underserved area females, the questionnaire survey and Pap. smear for uterine cervical cancer was done on total 330 women who lived in Ullungdo from 5th to 12th August, 1998. The results were summarized as follows： The age distribution of subjects was 50s (24.5%), 60s (24.5%) and their educational level was “no schooling” (14.2%) and “elementary school” (42.7%). The first coital age of subjects was 19∼21yrs (30.0%), 16∼18yrs (13.9%) and the first pregnancy age was 22∼24yrs (36.7%) and 19∼21yrs (30.0%). The frequency of total pregnancy of subjects was over 5 times (52.1%). The frequency of total delivery was “3∼4 times” (35.5％) and “5∼6 times” (15.2％). 68.8% of subjects had experience of abortion and 80.0% of their husband were on the phimosis. 172 (52.1%) subjects had gynecological symptoms, their symptoms were leukorrhea (48.3%), pruritus (21.5%) and leukorrhea with pruritus (20.3%). 63.9% of total subjects have been received Pap. smear and the frequency of their Pap. smear was “only 1 time” (44.1 ％), “irregularly” (30.3%) and the reason of respondents who have not been received Pap. smea. was “no specific symptom” (51.3%). Among the 330 women screened there were negative (45.8%), inflammation (47.3%), trichomoniasis and candidiasis (1.8%), atypical cells (4.5%) and dysplasia (0.6%).