Medical Professional Publications

When Should I Refer a Patient With Penile Adhesions to Urology?

Columbus, OH — March 2017

Seth A. Alpert, MDBy Seth A. Alpert, MD

Penile adhesions are one of the most common complications after routine neonatal circumcision. When the skin edges become irritated or inflamed in babies still in diapers, they can become adherent to one another and form adhesions. Skin bridges form shortly after circumcision during the healing process, when the bare skin edges fuse together if the skin is not appropriately pushed back and kept separated.

Penile adhesions without skin fusion often can be managed successfully with topical steroid cream as a first-line treatment. The provider should make sure to instruct caregivers (including the patients themselves, if they are old enough) that adhesions should be retracted manually while the cream is being used. I typically recommend Betamethasone 0.05% used twice a day. A common follow-up question is “When is it too late to use steroid cream?” My answer is that without skin fusion, it is not too late for a trial of medical management.

Adhesions that include true skin bridging and epithelialization of the skin edges generally won't respond to steroid cream because the skin is fused together. These may require an office procedure with local topical anesthesia in order to lyse the adhesions more precisely with instruments. Some very dense or extensive adhesions, particularly with significant redundant foreskin, may benefit from formal circumcision revision and/or lysis of the adhesions in the operating room with elective general anesthesia as an outpatient procedure.

If the steroid cream has failed or the adhesions are true skin bridges, then referral to urological specialist is completely appropriate.

In the long term, if not treated, these skin bridges will likely persist, may become denser, and could potentially cause pain with erections. They may also result in hygiene issues from accumulation of smegma, or cosmetic concerns for the patient and/or family members.

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