Mohammad Zafar Iqbal, Mushtaq Ahmad, Shumaila Irum, Tahir Mahmood.
Secondary phimosis after circumcision.
Pak J Med Health Sci Jan ;13(4):782-4.

Background : Circumcision is the removal of some or the entire foreskin (prepuce) from the penis. This is one of the oldest surgical procedures described in Egyptian papyri dating backs to 4000 BC, where the ancient mummies were found to be circumcised. Aim: To define this rare complication in terms of cause, findings, presentation, and treatment strategies. Technical error yielding to secondary phimosis will also be discussed. Methodology: The present study was performed in department of pediatric surgery Sheikh Zayed Medical College Rahim Yar Khan after approval from ethical review board (ERB). A total of 40 boys who were circumcised and admitted for treatment of secondary phimosis in last five years were included in the study. Results: Total 40 cases of children with post -circumcision secondary phimosis were seen. Primarily the presenting complaint was cosmetic issue in 22 (55%) patients, dysuria 7 (17.5%), retention of urine 6(15%) and urinary tract infection 5(12.5%) patients. circumcision of these patients was performed by pediatric surgeon 12(30%), general surgeon 9(22.5%), barber 9(22.5%), quack 8(20%) and pediatrian 2(5%). Bone cutter method was used in 15(37.5%), plastibell method in 9(22.5%), barber method in 9(22.5%), open free hand method in 4(10%) and gomco clamp in 3(7.5%). Secondary phimosis was commonly seen in chubby boys with thick pubic fat and buried penis. Conclusion: This study concludes that secondary phimosis is not a trivial complication. It occurs even in experienced hands if anatomical details especially thick pubic fat and buried penis are not checked.

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