Œįĺķġ ἴገጰᑋᱱ❚ᅝ╊ἴᅖሪሪᅖṗ⇞⇠◘᏷
ᑋᱱ❚⛟⁻ጰᗭἴገᅙᑺᒺጰᔘŀ
ᢍᑋᖮ➳⒄៻᥸ᅗᑋᱱ❚⛟⁻ጰᗭἴገᅗ᱑ᬧᛍ⃤ᠥ╊ἴᅙ᱑Ꮅᨬ
ᑆᠥᕶᑺἴገᅘἴገᏦᨬᑋᏩᬈጄᒭᱠ᥍ᖭᐡጄᯡᆇᏦᣂἴገᆈᅗ
ᙬἴገᰤᚑᏩᬈጄᒭᱠ᥍Ꮚᛵᯊᬈᒳὠᆇᯊᒳἴገᆈᅙᑋ☚Ꮟឹᴞ
ᢀᗡᛵᶋ᤺ጱᅗἴገᏻὲፇጄᯡᅗ᲌᯺ᚆῖᱱ❚ᅙĴĦᗭĶĦᛵᖎ⑟
ᑋᎤ᏷᥸᱑ጄᯡፁᏦᔝᑯᅙ᎘ᣞἡጱጟᱡᐡᗣ᪥ᱣᑺ᱑᫆◶ᅙᑋጙ
ᱡᐡ᱑ᗈ⑟ᗡጱᅗጄᯡᑋᎤ᏷ឹፁᵩ⛍✟ᅙᒣዯḠủ᥸ᅗ㊙ᑺIJĦ
ፁᏦጄᣂᅙᵩᒚᅗᑋᒀጴឹḢዯᕥጄᯡᗄጰᬈᖤᅙᑺᗈἴገ㊙៦Ḹ
Ủᙨᛵᰤᚑᱱ❚ጆ፵ᅗ᱑៦ᏻᚑ⃶ᨍፇ⚰ᐺἴገᛵᒠᒞᆇᴀἴᒠᆈ
ᬒዾ᮴፫ᙰᢄᅙ᱑ᬧᛍ⃤ᠥⓑᑇᙨἴገᅗᗄ᜾᧣ᏩᛵᏦᣂἴገᅗᎨ
ᨬዯᨷᏩᬈᅙἡἴገጰᨬᑋᱱ❚ᙬ⋧ᜬᱡᒳ⛟፛ᅗ᳍ᑺᎵᨬᔝᐨᕶ
ᑺἴገᅙᵩᒚᅗᑋጙᑑ∋᧔ᗓጱᅗ὚ᬺ៻፯ᰰᅗᱣᎵᑋὲፇᙬὲᜌ
ỲᮥᰤᕈᗭἴገᅙᑴᯆᅗᓉᎤ᏷➳ᢽᙬ❜᏷ᛵ⑟ᗡጱᅗ╊ἴᛵ⍶Ồ
➭ᷕ↾Ꭷᅙᑋᗥ᎘፵ᣃᏩᬈᛵ⑟ᗡጱᅗ⎃ᨌᓆᏸᯊᬈᎵᨬ៦᡽ឹ᝟
ᑆᅙ╊ἴᐑ៦ᑑ⃣ᐧ፞ᯊᬈ⃹ᑁ⇟ᛵᧁ╞ᅙ⑟ᗡᑙᑺᗣ᪥╊ἴ፛᏷
ᴻ⌸ᯊᬈᅗᎵᨬᑺᙨᓕፍፓᯊᬈᛵᬧᛍᅙ
197
Œįĺķġ ŕŦŴŵŪŴġůŰŵġŪůġŴŤųŰŵŶŮġĻġŤųźűŵŰųŤũŪŴŮᅖሪሪᅖ
ġ
ŅųġŘŰůŨġŕŢŬġʼnŪůŨĭġŃŪŭŭ
ŕũŦġŵŦŴŵŪŴġŤŢůůŰŵġţŦġŧŦŭŵġŪůġŵũŦġ
ŴŤųŰŵŶŮįġŘũŢŵ’ŴġŸųŰůŨŀ
If the testis cannot be felt in the scrotum during physical examination the
condition is called cryptorchism. This can be due to absence of the testis,
failure of the testis to move down fully along its natural path of descend
(undescended) or location of the testis in an abnormal site outside its path
of descent (ectopic). The testis moves from a location inside the abdomen
downwards to its final position in the scrotum during fetal development
in the late stage of gestation. In 3% to 5% of male babies the descent is
still incomplete at birth. A small proportion of them have the problem on
both side. In most of these babies the descent will continue after birth,
so that by 1 year of age only 1% remains undescended. However, further
descent after this is uncommon. Some testis only intermittently remains
in a position above the scrotum, due to strong retraction by the muscle
suspending the testis in the spermatic cord (cremasteric muscle). Such
a testis, called retractile testis, is not truly an undescended testis and it
usually functions normally. When a testis cannot be felt in the scrotum or
its surrounding, there is a chance that the testis might be totally absent.
However, in most cases, a testis can be found inside the abdomen or deep
in the groin on surgical exploration. Babies that are born prematurely,
with a low birth weight or are twins will have a significantly higher
chance of cryptorchism. In otherwise healthy babies, an abnormality
in activities of hormones may be the underlying cause. Cryptorchism
is a feature in various congenital abnormality syndromes. A baby with
bilateral cryptorchism and abnormal genitalia may be suffering from
abnormal sexual differentiation.
198
Œįĺĸġ ἴገጰᑋᱱ❚ᅝ╊ἴᅖሪሪᅖṗ⇞⇠◘᏷
ᑋᱱ❚⛟⁻ጰᗭἴገᅙᢢឿ↚␈ŀ
╊ἴᜳᎤἴገ⒲ᛵ⍶Ồῌ᪓ᅗ፾Ꮹᬈἴገ᪓ijĶᒣĴıᣑᅙ╊ἴᢄ⒲ᛵ
⍶ỒᡮᠥIJĦᅙᑇ᳞ἴገᏩᬈᒳὠᛵ፯ᰰᗄጰᕓ➦⒲᧕ᛵᶋ᧔ᮻᅙᵩ
ᒚᅗᰰឹᬟᜇᎵᕗᤶᚔ⒄៻ἴገᅗᑺᓛᬟᜇ፛ᑴ⁜⛞ᐞᒺάẋᙬᯊ
ᬈᅙἴገↅᢢዯᣥ፾➳֐ῌᓉᛵ֐ឯᅗᏩᬈḢᒭℽᱛ⃶ጛᅙ᎔፯ᰰ
᫶ἴገᚏᑇᱱ❚ᑺᓛῖᗭ᱑֐ឯᅙᑋዯ᪥╊ἴᅗ፯ᰰᎵᑇ᳞Ꮹᬈ᏷
ᖟᮻᅙᑋᗣ᪥╊ἴᅗᓟᗐ᪳ድ፯ᰰ᏷ᖟᮻፁ➭ᷕᵋᓉᅙῌᑴ᪳፯ᰰ
Ꮅᨬ⁝᏷ᖟᨬዾỒᑺῌᑗᶬᚤᅙᏦᣂἴገῌᚔᑋᒢጥᛵᒬ⃩ίጆᕅ
◓ᆇἴገᕅ◓ᆈᅗᒚᏦᣂἴገᡐ⁝ῌᘔᘷᛵᒳὠᐑᗐᏐᕗᚔᗽṢᅙ
ὲᜌỲᛲῌᬈᑋᏦᣂἴገᐹ᪥Ꭴᯀᅙ᱑ᗈ᫆◶ᱣᎵ᎔፯ᰰᾢᕰᅙ᫶
ἴገᚏᑇᱱ❚⁝ᖎវᛵᒢᔾᔲḁᐑ឴ᢽᢢᅙᑋᱱ❚⛟⁻ጰᗭἴገᛵ
⑟វ⑬፛ᑴᐿᛀᔣᡡ◘᏷᳌ᕧẤᖤᅙ➳⒄ឹᅗጙᱡᐡ᧔ዷ╊ἴᛵ⃣
⚎Ꮅ᎔ᓖᓕᅗⓑᑇᙨἴገᎵ᎔ῃ᧣ᏩᛵᏦᣂἴገፍ␇Ḷᗔᅙᢍἴገ
Ꮶᨬᑋᱱ❚፛⋧ᜬ≨Ჲ⛟⁻ᗭᅗᎵᨬↅᢢᑯ‡⒄៻᳌ᕈὲፇᛵἴ
ገᅙᒢᒭጄᯡᑋዯḠủឹ⚈᎔ᐪᑺḢ᤺ᅗ᱑᥸᳍⑬፛ᑴ᪳፯ᰰᅙ὚
ὲᜌỲፎጕᕈᎤἴገᅗᬉዹᱱ❚ᗄᎧ᎔ᘔᘷᅙὲፇἴገỒↅᢢᏸὲ
ᶾ♸ᗔ᳌ᕈᅗᐑᎵᨬↅᢢᗣḼ᠈ᛵ፯ᰰ᫶Ꮠᬉጄᗔᅙ
199
Œįĺĸġ ŕŦŴŵŪŴġůŰŵġŪůġŴŤųŰŵŶŮġĻġŤųźűŵŰųŤũŪŴŮᅖሪሪᅖ
ġ
ŅųġŘŰůŨġŕŢŬġʼnŪůŨĭġŃŪŭŭ
ŕŦŴŵŪŴġůŰŵġŧŦŭŵġŪůġŵũŦġŴŤųŰŵŶŮįġŘũŢŵġ
ůŦŦťŴġŵŰġţŦġťŰůŦŀ
Cryptorchid testis has a higher chance of developing cancer of the testis.
The risk is 25 to 30 times higher than that of a normal testis, and the actual
risk of cancer in an undescended testis is about 1%. Operation to restore the
normal position of the testis does not alter the chance of developing cancer.
However, after operation the patient himself can more easily examine the
testis, enabling him to notice any abnormal swelling or change earlier. The
testis needs a lower temperature than that of body temperature for normal
sperm production. Bringing the testis down to the scrotum by operation
would allow that temperature to be achieved. In unilateral cases, normal
chances to father a child can be restored by operation. In bilateral cases, such
chances are markedly reduced even after operation. Earlier operation may
produce better result in terms of fertility. An undescended testis is more prone
to twist on its vascular pedicle (torsion), yet the relatively fixed position of an
undescended testis also makes it more susceptible to trauma. Inguinal hernia
is more common in the same side of undescended testis. All these problems
can be addressed by operation. Replacing the testis inside the scrotum is
also important for the self-image of the boy. A baby in whom the testis is not
palpable in the scrotum should seek advice early from an urologist.
After physical examination, the type of cryptorchism could be sorted out in
most patients. Retractile testis could be differentiated from true undescended
cases. If the testis cannot be felt in scrotum or surrounding area, imaging
studies may be required to look for the testis inside the abdomen. Operation
should be done early when spontaneous descent is deemed unlikely to
precede any further after 1 year of age. The testis is explored through an
inguinal wound, brought down to the scrotum and fixed there. Laparoscopy
would be required to find the testis inside abdomen. Such testis may need to
be brought down by operation in two stages.
200
ŒįĺĹġ ᱱᰗḶጕᑋጄ፵ᅝᔣ῔ጄᷯᅖሪሪᅖṗ⇞⇠◘᏷
ᱱᰗḶጕᑋጄ፵ᅙᑺᒺጰᔘŀ
ἡᔣ῔Ḷጕᑋᱱᰗጄ፵ᆇὲ᪥ᆈ᥸ᅗ᱑ᬧᛍ⃤ᠥᔣ῔ጄᷯᅙᕦijĶı
ᑀᎤ᏷ᖎ⑟ጱᅗᓟᑺዯᑀᑺᒀᬧᛍᅙᑋᢀᗡ᥸ᅗᖎᙨᔣ῔ᏻᱱᰗጄ
፵ᗣ᪥┍ᩪ᯸▧⏠ᑁᒚᑯᅙ⏠ᑁጰᔝᐨỒ⍈ᢄᔣ῔ᅗᝥᩪ᯸▧፛Ꭹ
᐀ጄ፵ᛵᨖỂᅙ᪌ድὲ᪥ᔣ῔ḶጕᏊᅗᱱᰗᕗỒᑺ‡␴ጨᛵᎩ᐀ᅗ
᎔፛ᐿὲ᪥❟ᑸᆇẃᔲᱱᰗᆈᅙᔣ῔ጄᷯ៎ᔣ῔ḶጕᛵᒳὠᅗᎵፍ
ᠥ᝟ᅗጱ፛ឹ᳗⃣ᅙḶጕḏឹᅗἢᔲᛵᬧᛍḏ⚨ᢽᅙ⏠ᑁᑺ⏼Ṇ⎃
ᨌᛵᏩᬈᓆᏸᅙᔣ῔ጄᷯℚṆ⎃ᨌᛵℽᱛᙬ᎚┘ᨖᱴᅗᙬ᯸▧ᗽ➳
ᛵᨖỂᑺ⚆ᅙᏪ⏧☚Ꮟ᥸∎✿ᚑᖭ᎔⇝❀ᢀᗡ⎃ᨌ᠖᪳ᛵ⒭⁀ᒊ៭
ᛦᅗᎵᨬ៦ᑯᑆጴዯᅙᵩᒚᅗᑑ∋ᛵᔣ῔ጄᷯᗄᵨᚘ➭ᑯᑆᅙᏻᚑ
᱑ᬧᛍᑋᬟᜇᛵ᎟ᔰ፛ᗡጛጱῌᬈᖤᅗ៞Ꮅᨬ᦯፛␎Ṟᑆᨌᅙᑙጰ
ᎧⒺᏩᅗᬟᜇᛵᔣ៮Ồᪧ᭝ᐿጄᅙᾤᖎវỒᑆᱱᰗᛵᘟᧁᔲ፛ↅ
ᢢ♫ጄᗔጟᝅᒚ⋥↱ᔯᅙᑯᜳឹᅗ᎘Ồᑆᱱᰗ❟ᑸᒚ⚈᎔Ḣᒭᙨᒭ
ᠥᅙ᱑ᬧᛍᕗᎵᨬᒸᑺὲᜌỲᛲᅘᏦᣂἴገ፛␯⊆⎬ᮌᅙᵩᒚᅗᔣ
῅ᯊᬈᙬẦ៭ᛵᣉ␤ᝢዯᨷጰỒ↾Ꭷᅙᔣ῔ጄᷯᎵ᎔៦ᐧ፞ᯊᬈᛵ
⃹ᑁ⇟ጱᛵዯᱡᐡᅙᑺ⚨ᢽᔣ῔ጄᷯ፛ᗣ᪥╊ἴᛵᬟᜇ⑬ᢢ⒄៻ᑺ
ᵨᙨፍፓᛵᯊᬈᅙ
201
ŒįĺĹġ őŦůŪŴġŸŪŵũġŐűŦůŪůŨġŰůġŖůťŦųŴŪťŦĻġʼnźűŰŴűŢťŪŢŴᅖሪሪ
ġ
ŅųġŘŰůŨġŕŢŬġʼnŪůŨĭġŃŪŭŭ
őŦůŪŴġŸŪŵũġŰűŦůŪůŨġŰůġŶůťŦųŴŪťŦįġ
ŘũŢŵġŪŴġŵũŦġűųŰţŭŦŮŀġ
When the urethra opens on the underside (ventral) of the penis, the
condition is called hypospadias. The condition occurs in 1 per 250 live
male births. In the fetus, the male urethra is formed by fusion of two
folds from both sides on the underside of the penis. Incomplete fusion
will lead to defect in the inferior aspect of the urethra, erectile tissue and
prepuce. In additional to a ventral urethral opening, the penis will have
a hood like prepuce and a ventral curvature (chordee). Hypospadias is
classified into anterior, middle or posterior according to the location
of the urethral opening. The more posterior the opening, the more
severe would be the deformity. The fusion depends on normal action
of male hormones. Hypospadias is related to a defect in male hormone
production, metabolism or defect in the receptors in the tissue. Exposure
of the mother during pregnancy to environmental pollutants that affects
hormonal activity of the fetus is suggested as a cause. Majority of
hypospadias, however, do not have an obvious cause. There may be a
hereditary factor as the condition is more common in brothers and sons
of affected patients. Uncorrected, patients will have downward deflection
of urine stream. The boy will be ridiculed for the strange appearance of
his penis and his need to squat down to void urine. After growing up, he
will suffer difficulty in sexual intercourse due to the penile curvature.
The condition is also associated with inguinal hernia, undescended testis
and hydrocoele. However, there is usually no increased risk of urinary
tract abnormality or infection. Hypospadias can occur as a part of a
congenital abnormality syndrome. Patients with severe hypospadias and
bilateral undescended testes need to be investigated for abnormal sexual
differentiation.
202
Œįĺĺġ ᱱᰗḶጕᑋጄ፵ᅝᔣ῔ጄᷯᅖሪሪᅖṗ⇞⇠◘᏷
ᱱᰗḶጕᑋጄ፵ᅙᢢឿ↚␈ŀ
ᢢ᪳፯ᰰⒺᏩᱱᰗᛵἢᔲᅗጭᎵ⟇ᔣ៮ᑇ᳞Ꮹᬈ፵ᐿᅗ፛⟇᫶ᗔᎵ
ᏩᬈḢᒭᙨᐐᅙᒸᑺᛵᯊᬈᅗᑙὲᜌỲᛲᅘᏦᣂἴገ፛␯⊆⎬ᮌ
ᶟᅗᎵᚑᐹዯ፯ᰰጱᰤᮿᅙ፯ᰰዯᨷᑋፈᣥ፸ጙἡᱱᰗᜳᗭᡐἡጙ
ጟጴឹᅗ᎔፛ᑋIJĹᣥ፸ጙᬟᜇḶᘬᑙ᳙ᩡ≱ᅗ⁝Ꮚ᏷ᴻ⌸ῌ⛢⛞
ጴ᝟ᅗ፵ጭḢᒭᅙ፯ᰰᛵᐂ∕ᅗᎩ៘ⒺᏩᱱᰗ❟ᑸᅘឰᱛỉᛵᔣ
῔ᅘ᫶ỉᔣ῔ḶጕὠᚑᱱᰗᏧ⃨ᅗ᎔፛ᑇ᳞⑏␴፛ᔣ῔ጕᛵᏩᬈᔲ
ᆇᱱᰗ␴ᑯᔲᰰ፛ᔣ῔ጕᑯᔲᰰᆈᅙ᝟ᔣ῔ጄᷯዯᨷᎵ᎔⋧ᜬ᯸
▧☴ᣩᾚᅙῌឹᛵᔣ῔ጄᷯỒᏸጆᱱᰗᙬᎩ᐀᐀☴ᅙᑆᒀᅗᔣ῔ጄ
ᷯᛵᬟᜇᶮ⁝ጰᎵᬻᗽᎩ᐀ፎ᪌ᅗ᎔ᝉ᧒ᢽឰ᥸ᢢᏸᗭᛵᜨ᐀ᅙ᱓
ᬈᅗᣩᾚᎵ᎔ᑋዯḼ᠈ᛵ፯ᰰጱᔝᑯᅙᵩᒚᅗᑋ⚨ᢽᛵᙬ὚ጴ᝟ᣩ
ᾚᏌ᭗ᛵ᧔ᗓᅗ፯ᰰᎵᨬᢢፍᗣḼ᠈Ḣᒭᅙᣩᾚᔣ῔ጄᷯ៦ዯṌ⃶
᯶ᛵ፯ᰰᅗᑆᒀᗗᶋ᧕ጰ⚈ᶋ᏷ᅙᰰឹᑴᴞᅗṢጕᎵᨬᎤᒬᅘᑺ⎬
ᒬά᷂ᆇᒬάᆈᙬᗽẦ៭ᅙᏸᓆᢽឰᛵ᐀☴Ꮅᨬጰᨬᑜ᠖ᒚ᣻όᅙ
ጴឹᅗᑋỉᔣ῔ᐞᒺዯᰤᱣᎵ᏷ᨂᅗᔣ῔ᎤጕᐑᎵᨬᑳ⃽ᅙ᱑ᱣỒ
᜸☺ᔣ᠐ᅙ᲌Ⓨᛵ៦ᣩᾚᎵᨬ᧫ᷯᅗᔲᑯᑋጟᝅ᥸₩ᔣᛵ㢺⃩ᅙ᱑
ᗈᗗᶋ᧕ↅᢢᐪ᪳፯ᰰᰤᮿᅙᒚ᱑᱓ᬈᢢᶟᗭᜧᑿ፯ᰰᒣ፣Ꭾᑧ
ឹᅗᑗ⟇Ṣጕᶋᛝᦧᩳ፛᯸▧➦ᬗᕗ᪠ᬌᅙ
203
Œįĺĺġ őŦůŪŴġŸŪŵũġŐűŦůŪůŨġŰůġŖůťŦųŴŪťŦĻġʼnźűŰŴűŢťŪŢŴᅖሪሪ
ġ
ŅųġŘŰůŨġŕŢŬġʼnŪůŨĭġŃŪŭŭ
őŦůŪŴġŸŪŵũġŰűŦůŪůŨġŰůġŶůťŦųŴŪťŦįġ
ŘũŢŵġŤŢůġţŦġťŰůŦŀ
Surgical correction is required to correct the deformities of the penis
to allow a normal directed stream of urine and to allow normal sexual
intercourse in future. Associated abnormality such as inguinal hernia,
undescended testis and hydrocoele can be treated at the same operation.
Operation is usually done after 6 months of age when the penis has
grown to reasonable size, and before 18 months when the patient starts
toilet training and becomes more aware of his genitalia. Targets of the
operation include correction of the curvature of the penis, construction
of a new urethra, location of the new urethral opening to the tip of penis,
and restoration of a normal shape to the glans (glanuloplasty) and to the
urethral opening (meatoplasty). Anterior or distal hypospadias can usually
be repaired using flaps from adjacent tissues. More posterior or proximal
hypospadias would require flaps using prepuce or penile skin. It is therefore
imperative that a patient with hypospadias must not be circumcised so
as to preserve skin that may be used for reconstruction. The repair can
usually be accomplished in a single-staged operation. However, in severe
cases or in cases that have failed previous repairs, the operation may need
to be done in two stages. Hypospadias repair is a delicate operation, and
complications are thus not uncommon. Early after operation, there may be
bleeding, swelling of the tissue due to collection of blood (hematoma), or
infection of the wounds. Part of skin used for reconstruction may fail to
survive and may slough off. Later, narrowing can also occur anywhere in
the newly constructed urethra, and the external opening of the urethra may
become tight too, blocking the flow of urine. At its worst, the repair may
break down, resulting in urinary fistula that leaks urine during micturition.
These complications require repeat operation, which is usually delayed for
at least half a year after the initial operation to allow wound inflammation
to subside and tissue to become healthier before the next attempt.
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ŒįIJııġ Ꭹᰗ፛Ꭹ᐀⒭ፎᅖሪሪᅖṗ⇞⇠◘᏷
ᠻ↚ᬧᛍጄᢢᓆᎩ᐀⒭ፎŀ
⑟ᗡᜧ᏷᥸ᅗᎩ᐀Ꮹᬈℚ⑏␴ᆇᱱᰗ␴ᆈ╝᱕ᅙᏐ₰₰ℚ⑏␴ፍ
◪ᅗᗭጃủ᥸ᅗĺıĦᛵᎩ᐀ጥᎵᔝᐨᬙ⑏␴▰Ḷᅙᑋᒢᵩፍ◪᝟ᏸ
ዾᾦ‽▰ḶᎩ᐀Ồ፫ᩪᎤᒬ፛ᶬᡂᅙᎩᰗ៦។Ꭹ᐀Ḷጕᧃᨂᅗᔏ☺
Ꭹ᐀ᬙ⑏␴▰ḶᅙᎩᰗᎵ፫ᩪ⑏␴᳞ᶋᙨẦ៭ᆇᱱᰗ␴ᛝᆈ፛Ḹጱ
⍈ᢄ⑏␴ᰳᧃᨂᛵᎩ᐀᪰⃽ᅗᱛᑯᶄổᆇ᳎ Ꭹᰗᆈᅙᑺ᱑ᗈᗗᶋ
᧕ᛵᎩᰗᅗᙬጟវᑧ✃ῌጙ᥸ፁᏦᒢᵩፍ◪ᛵᎩ᐀ᅗ᳍ↅᢢᓆᎩ᐀
⒭ፎᅗ᪳፯ᰰፎ᪌Ꭹ᐀ᅙᒀᏊᅗᎩ᐀⒭ፎᐑᑺᑆᠥ∬ᑋᛵ◘⍆ጆᛵ
ᑗᰤᒚᬗᗭᴀᣤᅙ᱑ᗈᑗᰤᎩ៘ᵋ፣ᔣ῅Ầ៭ᛵᶋ᏷ᅘ ᖿᎩᰗ፛
ᗥᗗᶋ᧕ᅘᦧ᪌ᱱᰗ⒲ᛵᣉ␤፛ᵋᓉẦ៭ᙨṞ∂᧓᧔ᛵᐶ␤ᅙἡᤲ
ᜳầᠥ᱑ᗈᑗᰤᒚᢢᗡጛᬻᗽᎩ᐀⒭ፎ᥸ᅗ⑬᫶᱑ᗈᑗᰤῃ፯ᰰᛵ
ᶄổ፛Ꮅᨬᑺᛵᗗᶋ᧕⏡Ḫዯጄᅗᗓᑙ፯ᰰᎵᨬᑺᎤᒬᅘẦ៭ᅘṢ
፛ᱱᰗᙬፎ᪌῜ᑑᜨ᐀ᶟᅙ᪡⃃ᅗᎩ᐀ḶጕᐑᎵᨬᐪᑳᨂᅙᑋ᏷ᑺ
ᱱᰗᯊᬈᅗᑙᔣ῔ጄᷯᛵᗡᶝᅗᎵᨬᢢᏸᗭᎩ᐀ᓆᢽឰ፯ᰰᅗ᳍ጰ
⑬ᓆᎩ᐀⒭ፎᅙᑋᑺᎤᒬṠᐿᙬ⚨ᢽ᧓᧔ᛵᬟᜇᅗᛸᒣ᱑ᗈᬧᛍᬗ
ᗭᕓᶷጴ᝟ᅗ፯ᰰᐑ᲌ᑗ┭ᓑᅙ
205
ŒįIJııġ őũŪŮŰŴŪŴġŢůťġŤŪųŤŶŮŤŪŴŪŰůᅖሪሪ
ġ
ŅųġŘŰůŨġŕŢŬġʼnŪůŨĭġŃŪŭŭ
ŘũŦůġŸŪŭŭġŤŪųŤŶŮŤŪŴŪŰůġţŦġůŦŤŦŴŴŢųźŀ
The prepuce or foreskin is normally adherent to the glans in a newborn.
It gradually separates from the glans so that by age 3, 90% of prepuce
can be completely retracted from the glans. Forceful attempts to retract
the prepuce before natural separation occurs can lead to bleeding and
scarring. Phimosis is a constriction or narrowing of opening of the
prepuce that prevents the prepuce to be retracted away from glans.
Phimosis can lead to recurrent infection of the glans (balanitis) and
occasionally a painful constriction of the glans by the tight prepuce
(paraphimosis). In a child with these complications due to phimosis, or in
an older child with failure of natural separation, circumcision, or surgical
removal of the prepuce, is required. Furthermore, circumcision has been
advocated for its potential medical advantages, which include reduction
of incidence of urinary tract infection, prevention of phimosis and its
complications, elimination of the risk of penile cancer and reduction in
the risk of contracting sexually transmitted disease. Parents who wish to
subject their children to circumcision for these advantages need to weigh
these advantages against the pain and possible complications associated
with the operation, like bleeding, infection, penile or urethral injury
or excessive skin removal. Recurrence of narrowing of the preputial
opening may rarely occur. Circumcision should not be done in a child
with penile abnormality such as hypospadias as the prepuce may be
necessay for subsequent reconstruction. It is also preferably avoided in
a child with bleeding tendency or other severe medical problems, until
these problems have been resolved.
206