{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:07:47Z","timestamp":1770505667188,"version":"3.49.0"},"reference-count":16,"publisher":"BMJ","issue":"6648","license":[{"start":{"date-parts":[[1988,9,3]],"date-time":"1988-09-03T00:00:00Z","timestamp":589248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1988,9,3]]},"abstract":"<jats:p>In most boys referred for circumcision preputial adhesions are the only problem, but these can predispose to recurrent balanitis. A simple technique using Emla cream (eutectic mixture of lignocaine and prilocaine) has been devised which allows the adhesions to be separated painlessly in the outpatient clinic. The technique was used on 39 boys aged 2 to 12 years referred for circumcision, none of whom had a retractable foreskin. The cream was applied under an occlusive dressing and left for 60 minutes before the adhesions were separated with a probe and a gauze swab. The procedure was completely pain free in 32 boys. One boy had to undergo a repeated procedure because he failed to follow the advice regularly to retract his foreskin in the three weeks after the procedure. Only one boy had to undergo circumcision later because of fibrous phimosis. In many boys referred for circumcision separation of preputial adhesions is all that is needed, and the use of this local anaesthetic technique avoids the need for general anaesthesia.<\/jats:p>","DOI":"10.1136\/bmj.297.6648.590","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"590-591","source":"Crossref","is-referenced-by-count":31,"title":["Save the prepuce. Painless separation of preputial adhesions in the outpatient clinic."],"prefix":"10.1136","volume":"297","author":[{"given":"G. A.","family":"MacKinlay","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1988,9,3]]},"reference":[{"issue":"4","key":"ref_1","first-page":"583","article-title":"A fityma (preputium) seites adatapadasa a makkoe gyermakelnel","volume":"1860","author":"Bokai, J.","unstructured":"Bokai J. A fityma (preputium) seites adatapadasa a makkoe gyermakelnel. Orv Heill 1860;4:583-7.","journal-title":"Orv Heill"},{"key":"ref_2","first-page":"639","article-title":"Phimosis and dvsuria in infaney. A clinical investigation","volume":"ii:","author":"Hamilton, A.J.C.; Middleton, D.S.","year":"1927","unstructured":"Hamilton AJC, Middleton DS. Phimosis and dvsuria in infaney. A clinical investigation. Latncet 1927;ii:639-46.","journal-title":"Latncet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1002\/ar.1090570409","article-title":"'I'he separation of the prepuce in the human penis","volume":"54","author":"Deibert, G.A.","year":"1933","unstructured":"Deibert GA. 'I'he separation of the prepuce in the human penis. Anat Rec 1933;54:387-93.","journal-title":"Anat Rec"},{"key":"ref_4","first-page":"1433","article-title":"'I'he fate of the foreskin","volume":"ii:","author":"Gairdner, D.","year":"1949","unstructured":"Gairdner D. 'I'he fate of the foreskin. BrMedy 1949;ii: 1433-7.","journal-title":"BrMedy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1542\/peds.79.3.338","article-title":"Declining frequency of circumcision: Implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy","volume":"79","author":"Wisewell, T.E.; Enzenauer, R.W.; Cornish, J.D.; ei al","year":"1987","unstructured":"Wisewell TE, Enzenauer RW, Cornish JD, ei al. Declining frequency of circumcision: Implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy. Pediatrics 1987;79:338-42.","journal-title":"Pediatrics"},{"key":"ref_6","first-page":"252","article-title":"Causes of copulatory failure in beef bulls. Mod Vt lPraci","volume":"65","author":"Walker, D.F.","year":"1984","unstructured":"Walker DF. Causes of copulatory failure in beef bulls. Mod Vt lPraci 1984;65:252-6."},{"key":"ref_7","first-page":"84","article-title":"Circumcision for phimosis: a follow up study","volume":"20","author":"Stenram, A.; Malmfors, G.; Okmian, L.","year":"1986","unstructured":"Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow up study. ScandJ Lrol Nephrol 1986;20:84-92.","journal-title":"ScandJ Lrol Nephrol"},{"key":"ref_8","first-page":"1133","article-title":"Current concepts in the management of common urologic problems in infants and children. 1'ediair Cli)i","volume":"32","author":"Anderson, G.F.; Smey, P.","year":"1985","unstructured":"Anderson GF, Smey P. Current concepts in the management of common urologic problems in infants and children. 1'ediair Cli)i North Am 1985;32: 1133-47.","journal-title":"North Am"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1136\/bmj.286.6360.186","article-title":"'I'herapeutic retraction of the foreskin in childhood","volume":"286","author":"Cooper, G.B.; Thomson, G.J.L.; P'AM, Raine","year":"1983","unstructured":"Cooper GB, Thomson GJL, Raine P'AM. 'I'herapeutic retraction of the foreskin in childhood. Br Medy 1983;286: 186-7.","journal-title":"Br Medy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/S0140-6736(84)92706-5","article-title":"Non-surgical separation of preputial adhesions","volume":"2","author":"Griffiths, D.M.; Freeman, N.V.","year":"1984","unstructured":"Griffiths DM, Freeman NV. Non-surgical separation of preputial adhesions. Lancei 1984;2:344-5.","journal-title":"Lancei"},{"key":"ref_11","first-page":"997","article-title":"Dermal effects ofcomposition based on the eutectic nature of lignocaine and prilocaine. Br Y7 Anaesih","volume":"57","author":"Eversh, Von Dardel 0, Juhlin L","year":"1985","unstructured":"Eversh, Von Dardel 0, Juhlin L, et al. Dermal effects ofcomposition based on the eutectic nature of lignocaine and prilocaine. Br Y7 Anaesih 1985;57: 997-1005."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/00000542-198210000-00024","article-title":"Does lignocaine-prilocaine cream permit painfree insertion of IV catheters in childrcn?","volume":"57","author":"Hallen, B.; Uppfeldt, A.","year":"1982","unstructured":"Hallen B, Uppfeldt A. Does lignocaine-prilocaine cream permit painfree insertion of IV catheters in childrcn? Anesthesiology 1982;57:340-2.","journal-title":"Anesthesiology"},{"key":"ref_13","first-page":"544","article-title":"A lidocaine-prilocainecream for superficial skin surgery and painful lesions","volume":"60","author":"Juhlin, L.; Evers, H.; Broberg, F.","year":"1980","unstructured":"Juhlin L, Evers H, Broberg F. A lidocaine-prilocainecream for superficial skin surgery and painful lesions. Acda Derm V'eereol (Siockh) 1980;60:544-6.","journal-title":"Acda Derm V'eereol (Siockh)"},{"key":"ref_14","first-page":"902","volume":"ii:","author":"on circumcision, Spence","year":"1964","unstructured":"Spence on circumcision. Lantei 1964;ii:902.","journal-title":"Lantei"},{"key":"ref_15","first-page":"365","article-title":"Hvgienic care in uncircumcised infants","volume":"67","author":"Osborn, L.M.; Metcalf, T.J.; Mariani, E.M.","year":"1981","unstructured":"Osborn LM, Metcalf TJ, Mariani EM. Hvgienic care in uncircumcised infants. 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