Penile adhesions after neonatal circumcision

Purpose: The appropriate management of penile adhesions in circumcised boys is unclear. An important consideration is whether adhesions resolve sponta neously. We studied the incidence of penile adhesions as a function of pati ent age to assess the natural history. Materials and Methods: We evaluated all circumcised boys presenting to our pediatric urology clinic. A standard form was used to classify adhesions as grade 0-no adhesions, 1-fine adhesions to the corona, 2-adhesions covering less than 50% of the glans and 3-adhesions covering greater than 50% of th e glans. All boys were evaluated by 1 of 2 pediatric urologists. Previous t reatment of adhesions was assessed and skin bridges were also noted. Results: We enrolled in our study 254 boys 1 month to 19 years 8 months old . Only 7 patients had a history of treatment of adhesion, of whom 3 had rec urrent adhesions at evaluation. Patients were divided into groups based on age, including younger than 12 months (61), 13 to 60 (78), 61 to 108 (51) a nd 109 months old or older (64). In these groups we noted an adhesion rate of 71%, 28%, 8% and 2%, respectively. The rate of adhesions more severe tha n grade 1 was 30%, 10% and 0% in boys 12 months old or younger, 13 to 60 an d 61 months old or older, respectively. The oldest patient with grade 3 adh esions was 31 months old. Skin bridges in 6 cases involved the circumcision line in 4. Conclusions: Penile adhesions develop after circumcision and the incidence decreases with patient age. Although there is debate on whether to lyse the se adhesions manually, our findings suggest that adhesions resolve without treatment. Based on our results we do not recommend lysing penile adhesions , except perhaps those involving the circumcision line.