Paediatric Urology
Phimosis
A phimosis occurs when the foreskin is too tight and closed over the head of the penis (glans).
The majority of boys are born with phimosis (physiological phimosis), which normally resolves on its own in about 50% of 1-year-old boys and 90% of 3-year-old boys. Less than 1% of boys aged 16 – 18 years have a physiological phimosis. Some boys develop phimosis over time (pathological phimosis). This is caused by scarring of the foreskin, often secondary to a chronic inflammatory condition called “balanitis xerotica obliterans” (BXO). Pathological phimosis can cause painful erections; repeated infections of the bladder or kidneys (urinary tract infections); inflammation in the skin penis glans (balanitis); pain and difficulties urinating. Pathological phimosis can be treated in two ways: using topical steroids or undergoing a circumcision (surgical removal of the foreskin). A steroid cream is applied on the foreskin twice a day for up to 3 months; this can be effective in 50% of children. The circumcision is done by Dr Pacilli solely under general anaesthesia as a day procedure. In Victoria, circumcision can be performed in a public hospital only for a pathological phimosis. Dr Pacilli does not offer circumcision in neonates and infants in the rooms, but he is happy to offer a circumcision for cultural or religious reasons in older children that can be performed in a private hospital.
Undescended testicle
This occurs when the testicle is not in the scrotum. Generally, only one side is affected, but occasionally, both testicles fail to travel to the scrotum.
The testicles develop inside the abdomen, and during pregnancy they travel through a passage into the scrotum. Testicles should be into the scrotum by 1 year of age. Around 5-10% of boys are born with an undescended testicle; in about 1-2% of cases, the testicle remains undescended.
In some children, the testicles may be in the scrotum but they naturally rise back into the body in cold temperatures; you can usually encourage the testicles out by putting your child in a warm bath. These are called “retractile testicles” and they do not need intervention.
True undescended testicles cannot be located in the scrotum and will require surgery under general anaesthetic called an orchidopexy, as they do not seem to mature properly.
The amount of sperm and fertility levels seem lower in men who have had undescended testicles, especially if they were not treated early in childhood. This is because the testicles need to be a few degrees cooler than the rest of the body to function properly. Children with undescended testicles also have a higher risk of testicular cancer in the future. When the undescended testicles are treated in early childhood, the outlook is good, and your child should have normal fertility levels, unless there were problems with the testicles themselves.
Varicocele
A varicocele occurs when veins in the scrotum have become enlarged and swollen (dilated); it occurs in teenage boys and mostly in the left testicle. This is similar to the varicose veins that occur in the legs.
Most boys with a varicocele don't have any symptoms but some experience heavy feeling, and/or a dull ache in the testicles, that get worse during or after exercise. Occasionally, the testicle is smaller than the other one, and swollen blood vessels can be seen or felt in the scrotum.
An ultrasound scan is generally performed to measure the size of the testicle. Treatment will depend on your child’s symptoms, mostly on the severity of pain and the size of the testicle. If untreated, a varicocele may affect fertility (ability to have children) later, although this is the case in only 1/3 of patients.
Surgery can restore proper blood flow in the scrotum and potentially preserve fertility. Treatment may include surgery or other methods to take out or block the vein with the varicocele.
Disclaimer: Please note that the information contained on this website should not be used for the diagnosis or treatment of any medical condition. If you have specific questions about how the information relates to your child, please ask your doctor.