Is it possible to catheterize an uncirc'd baby boy without retracting him?

[Annie Laurie]

I need reassurance and am hoping someone has info or experience with this.

 

I'm 32 weeks pregnant with a baby boy who has been diagnosed with kidney reflux in utero. At 20 weeks I was told it was hydronephrosis, at 30.5 I was told it was downgraded to reflux, which has a good chance of resolving itself.

 

But baby will need to see a pediatric urologist and will probably need a procedure called a VCUG which involves inserting a catheter. Baby will not be circumcised, and I've had bad experiences with medical personnel trying to retract my other uncirc'd boy and have had to be vigilant. It was easy with him, just to say "Do not touch his penis. Period."

 

But I can not say that with this baby, if he needs a catheter. I'm very concerned that because circumcision is the norm in the US, I'll end up with people who don't know how to cath an uncirc'd male, and they'll forceably retract him and cause adhesions and other unnecessary trauma.

 

I'm feeling demoralized, because I've done a lot of searching and can find hardly anything about cathing an uncirc'd male, and so many moms online have told me he'll just have to be retracted and it's no big deal.

 

Well, it is a big deal to me. I feel like it will be so hard to protect my baby from unnecessary pain and trauma.

 

Any advice for me? Has anyone had their uncirc'd boy catheterized without retraction and trauma? :(

 

I'd prefer this not become about circing vs not circing.

[joannqn]

My DS3 was hospitalized at 2 weeks for a UTI and RSV. Because of that, they did testing for reflux on him. He wasn't circumcised and they put a catheter in him just fine.

 

He had another a short time later. Circumcising him was suggested by more than one doctor but, knowing that most boys who have UTIs are fine after the age of 1, I held my ground. He's still not circumcised, and he hasn't had another UTI since that second one.

 

ETA: And his foreskin is still adhered, not retractable.

[Laura Corin]

Calvin had exactly the same issue. Very few babies are circumcised in Britain, so it was a normal procedure for the doctors here. As far as I remember, the foreskin was retracted just a little bit, enough for the doctor to see his way, but we have seen no ill effects - adhesions, etc. This is backed up by a reference on this page.

 

Calvin did cry - it was explained to us that the fluid feels strange and chilly. He calmed down though and there was no infection or continuing pain after the procedure.

 

Best wishes

 

Laura

[Tangerine]

Have you tried the Mothering.com boards? A thread search there might yield you a lot of information.

[Nakia]

I am a nurse, but I have never had to cath a baby, thank the Lord! But I do know from assessing uncirc'ed baby boys that you can see the meatus well enough that I am certain the catheter can be inserted without retracting the foreskin. There is no reason whatsoever that the foreskin would need to be retracted simply to insert a catheter. The catheter they use will be tiny and should be easily slipped into the small opening at the tip of the foreskin right into the meatus. Be firm and tell them retracting the foreskin is not acceptable!

[Mama_Rana]

Have you tried the Mothering.com boards? A thread search there might yield you a lot of information.

I second this, because:

 

I am a nurse, but I have never had to cath a baby, thank the Lord! But I do know from assessing uncirc'ed baby boys that you can see the meatus well enough that I am certain the catheter can be inserted without retracting the foreskin. There is no reason whatsoever that the foreskin would need to be retracted simply to insert a catheter. The catheter they use will be tiny and should be easily slipped into the small opening at the tip of the foreskin right into the meatus. Be firm and tell them retracting the foreskin is not acceptable!

 

I've heard the same thing. I would make sure to discuss it ahead of time, BEFORE anyone touches his penis, and with the doctor before the procedure at all, with documentation if necessary. Just because one baby didn't get adhesions from being retracted, doesn't mean another won't.

 

Good luck :grouphug:

[kokotg]

My middle DS had kidney reflux and is uncirc'd. He had to have a catheter several times by the time he was a few months old...this has been 7 years ago, but, as I recall, they pull the foreskin back just enough to see the opening. I remember reading something at the time (because I had all the same concerns you do) about it being possible to put the catheter in "by feel"...but honestly, I'm not sure that's really better than pulling the foreskin back just enough to see the opening. I'd just be really up front about your concerns any time he's cath'd and watch him like a hawk to make sure they don't do more than they need to do. I remember asking the nurses who were doing the catheter one time if they had experience with uncircumsized babies, and they just kind of laughed and assured me they did it all the time (this was at a big, urban, pediatric hospital). Things vary by region, of course, but the stats on circ/not circ'd are pretty close to 50/50 in the US as a whole now, so it's unlikely you'll get anyone who's not used to dealing with uncircumsized babies.

 

I worried and worried and worried and researched and researched researched when Milo was a baby....and I was relieved that his foreskin was never an issue WRT to the reflux. No one we saw--from the perinatalogist to the pediatrician to the urologist to any of the nurses EVER suggested we should circumsize him because of it. It was a lot to deal with when he was a baby--we did all the testing and put him on prophylactic antibiotics when he was very young, and he wound up getting a breakthrough UTI anyway, so he had surgery when he was 5 months old (he had stage 5 reflux, though, which is the most severe and least likely to resolve on its own)--but after the surgery he was 100% fine. So all of that to say--I'm sorry you and your babe have to deal with all the tests and worries--but you'll come through it just fine, and it's so good that you know about it now; a lot of kids get multiple UTIs before they're finally diagnosed.

[Annie Laurie]

My DS3 was hospitalized at 2 weeks for a UTI and RSV. Because of that, they did testing for reflux on him. He wasn't circumcised and they put a catheter in him just fine.

 

He had another a short time later. Circumcising him was suggested by more than one doctor but, knowing that most boys who have UTIs are fine after the age of 1, I held my ground. He's still not circumcised, and he hasn't had another UTI since that second one.

 

ETA: And his foreskin is still adhered, not retractable.

 

Finally! Someone who has an uncirc'd boy who had a cath without trauma. Thank you, thank you for sharing yoru experience.

 

Calvin had exactly the same issue. Very few babies are circumcised in Britain, so it was a normal procedure for the doctors here.

 

I wish I lived somewhere where not circing was the norm.

 

Have you tried the Mothering.com boards? A thread search there might yield you a lot of information.

 

I don't know why I keep forgetting about MDC. I just posted, thanks for the reminder.

 

I am a nurse, but I have never had to cath a baby, thank the Lord! But I do know from assessing uncirc'ed baby boys that you can see the meatus well enough that I am certain the catheter can be inserted without retracting the foreskin. There is no reason whatsoever that the foreskin would need to be retracted simply to insert a catheter. The catheter they use will be tiny and should be easily slipped into the small opening at the tip of the foreskin right into the meatus. Be firm and tell them retracting the foreskin is not acceptable!

 

Thank you so much for the reassurance! I definitely do plan on discussing this beforehand and making it clear that we do not want him retracted. Dh and I have agreed that we'll ask for someone with experience with cathing an uncircumcised boy, and we'll keep looking until we find someone.

 

I second this, because:

 

 

 

I've heard the same thing. I would make sure to discuss it ahead of time, BEFORE anyone touches his penis, and with the doctor before the procedure at all, with documentation if necessary. Just because one baby didn't get adhesions from being retracted, doesn't mean another won't.

 

Good luck :grouphug:

 

I completely agree. Dh is better with people than I am and has told me he'll be with me at every appointment and we will discuss it ahead of time with the people performing the procedure. I definitely do plan to take the info from the AAP that stays an intact penis should not be forceably retracted. And then I will document that we discussed this, because there's gonna be hell to pay if they retract him anyway.

 

My concern is that someone who is just clueless will assure us that they won't retract and then will do it anyway, and it will be hard for me to tell because they're inserting a cath, until it's too late and they've traumatized my baby.

 

I'm wondering if dh or I should insist on being the ones to hold the very tip of baby's foreskin back enough for them to see the urethra opening and insert the cath, therefore insuring they can't pull it back where skin is adhered.

[Annie Laurie]

This is what I've read, with the addition that once the meatus is visuallized, they pull the end of the foreskin away from the body slightly--not away from the penis at all, but in the same direction it's going, toward the end of the penis (I'm thinking just to just hold the opening steady and open?), and then the catheter should slip in easily. It's hard for me to describe that, but where I read it, it totally made sense, and was verified by several nurses or parents who had seen it done that that was the way it was done without any need for retraction.

 

K, If you find where you read that, please link me to it. I'd like to have actual info on that with me.

[Annie Laurie]

My middle DS had kidney reflux and is uncirc'd. He had to have a catheter several times by the time he was a few months old...this has been 7 years ago, but, as I recall, they pull the foreskin back just enough to see the opening. I remember reading something at the time (because I had all the same concerns you do) about it being possible to put the catheter in "by feel"...but honestly, I'm not sure that's really better than pulling the foreskin back just enough to see the opening. I'd just be really up front about your concerns any time he's cath'd and watch him like a hawk to make sure they don't do more than they need to do. I remember asking the nurses who were doing the catheter one time if they had experience with uncircumsized babies, and they just kind of laughed and assured me they did it all the time (this was at a big, urban, pediatric hospital). Things vary by region, of course, but the stats on circ/not circ'd are pretty close to 50/50 in the US as a whole now, so it's unlikely you'll get anyone who's not used to dealing with uncircumsized babies.

 

I worried and worried and worried and researched and researched researched when Milo was a baby....and I was relieved that his foreskin was never an issue WRT to the reflux. No one we saw--from the perinatalogist to the pediatrician to the urologist to any of the nurses EVER suggested we should circumsize him because of it. It was a lot to deal with when he was a baby--we did all the testing and put him on prophylactic antibiotics when he was very young, and he wound up getting a breakthrough UTI anyway, so he had surgery when he was 5 months old (he had stage 5 reflux, though, which is the most severe and least likely to resolve on its own)--but after the surgery he was 100% fine. So all of that to say--I'm sorry you and your babe have to deal with all the tests and worries--but you'll come through it just fine, and it's so good that you know about it now; a lot of kids get multiple UTIs before they're finally diagnosed.

 

Thanks! That's reassuring!

 

I know that we could be dealing with something a lot worse, I think pregnancy hormones kicks the anxiety and mama bear stuff into overdrive.

[Quiver0f10]

My DS3 was hospitalized at 2 weeks for a UTI and RSV. Because of that, they did testing for reflux on him. He wasn't circumcised and they put a catheter in him just fine.

 

Same here.

[Ottakee]

You could also call the hospita ahead of time--even before he is born and ask their policies. Ask for the tech with the MOST experience with newborns to do this.

[bbrandonsmom]

I agree w/ MDC too :) One other thing-is this going to be done immediately after birth? Whether it is or not though, find out if you or dh can be there and be insistent about it. They obviously can't do a retraction w/ one of you there, right?

I don't trust the hospital at all. With ds1, I had notes posted all over him to not circ him, not give him formula, not give him a pacifier, not take him from my room etc. They still tried-everything! Our medical system can be amazingly ignorant of us when they chose to be. Every single wbv too almost, they wanted to retract him-what's with that?

Anyhow, good luck. Persist w/ what you want. Get it in writing if possible that they will not retract, seeing as pp have had a catheter and not had to have a retraction done. Hopefully, all will be fine when he's born.

[Annie Laurie]

You could also call the hospita ahead of time--even before he is born and ask their policies. Ask for the tech with the MOST experience with newborns to do this.

 

I agree w/ MDC too :) One other thing-is this going to be done immediately after birth? Whether it is or not though, find out if you or dh can be there and be insistent about it. They obviously can't do a retraction w/ one of you there, right?

I don't trust the hospital at all. With ds1, I had notes posted all over him to not circ him, not give him formula, not give him a pacifier, not take him from my room etc. They still tried-everything! Our medical system can be amazingly ignorant of us when they chose to be. Every single wbv too almost, they wanted to retract him-what's with that?

Anyhow, good luck. Persist w/ what you want. Get it in writing if possible that they will not retract, seeing as pp have had a catheter and not had to have a retraction done. Hopefully, all will be fine when he's born.

 

We'll be having a homebirth so no worries about anything being done immediately, but I will have to find out how soon after birth this needs to be done.

[joannqn]

The procedure wasn't without trauma, though the trauma was from being strapped to the board rather than the catheter. They need baby to not move while they insert the liquid and he pees it back out so they can see what they need to see on the scan.

[Annie Laurie]

The procedure wasn't without trauma, though the trauma was from being strapped to the board rather than the catheter. They need baby to not move while they insert the liquid and he pees it back out so they can see what they need to see on the scan.

 

Thanks for the heads up! I've read about that and am not looking forward to it, but I know we need to stay up on his kidneys so as to prevent any scarring. If they can just not retract him and his penis is pain free afterward, I'll be happy.

[Ottakee]

We'll be having a homebirth so no worries about anything being done immediately, but I will have to find out how soon after birth this needs to be done.

 

I would find this out ahead if you can. You don't want a kidney infection to set in. Make sure the peds. urologist has a "heads up" this is coming up as it might be a bit different with a home birth. With a hospital birth they would likely set up the consult within the first 24 hours and then do the test soon afterwards.