A lawsuit just filed in Atlanta, GA, alleging that a hospital allowed (or required) a forcible, foreskin retraction injury to an intact (not circumcised) boy, might help reveal the professional ignorance of basic anatomy that allows these permanent injuries to occur. Avery’s Neonatology, for instance, admits such ignorance is widespread:
“Because circumcision is so common in the United States, the natural history of the preputial [foreskin] development has been lost, and one must depend on observations made in countries in which circumcision is usually not practiced.” — Avery’s Neonatology: Pathophysiology and Management of the Newborn, MacDonald (ed.) Lippincott, 2005:1088.
Parents call or write D.O.C. over 100 times each year to report their intact son was injured by PFFR – premature, forcible, foreskin retraction. We now have over 1,000 injury cases on file. About 20% of these incidents involve boys who were forcibly and painfully retracted to insert a urinary catheter merely to diagnose urinary tract infection, when less-intrusive methods are available.
These are D.O.C’s thorniest cases. When pressed, hospitals typically argue that they retracted the boy “for antisepsis” and that this is their standard protocol. But one could fairly ask, “Why would you tear open a sterile part of the body in order to sterilize the now raw and bleeding tissue that was closed and sterile to begin with?”
A recent Swiss training video, published by the New England Journal of Medicine, shows a much more humane and sensible method of gentle catheterization, one that does not compromise antisepsis or destroy the boy’s protective balano-preputial lamina (the natural tissue connecting the inner foreskin to the glans in young children).
Also, a recent article, published in the March 2017 issue of Canadian Family Physician, sets forth the evidence-based logic of the better procedure: “Catheterization without foreskin retraction,” co-authored by urologist Adrienne Carmack, MD and Marilyn Fayre Milos, RN.
Why are these proven methods not standard practice in all American hospitals?
Read the facts of the Atlanta case – typical in our experience – and consider whether a hospital should be able to ignore fundamental anatomy, defy the parents, and evade well-known informed consent principles with impunity?
Post revised 16 Jan 2018