period), or freehand (older boys), most postoperative bleeding will resolve with manual pressure for to 10 minutes After that, careful inspection will reveal if there is a discrete vessel bleeding, or if there is more general oozing of blood from the suture line Urology consultation is recommended if there is concern for injury to the glans or urethra or if bleeding does not stop with manual pressure Delayed Concerns If there is concern for a skin cicatrix, a thick scar around the edge of the circumcision, encasing the urethral meatus, then the patient should be referred to the urology clinic for outpatient follow-up This can be done as a routine visit unless there is concern for obstruction of the urinary stream, although this is very rare If a scar is caught early, it may respond to gentle release of flimsy adhesions, or, if a more robust scar, it may respond to treatment with betamethasone cream In severe cases, a circumcision revision will have to be performed in order to release the scar around the glans Phimosis and Paraphimosis Goals of Treatment Rule out significant skin or glans infection in cases of phimosis Reduce foreskin back to normal anatomic location in paraphimosis Clinical Considerations Phimosis exists when the distal foreskin becomes scarred so that it cannot be retracted to expose the glans This nonretracted foreskin is a normal physiologic finding in the newborn and infant However, this can also persist or occur later in life as a result of inflammation from chronic urine exposure, previous forceful withdrawing of the foreskin over the glans, or related to lichen sclerosus Children may present with swelling of the foreskin, or with the complaint of seeing ballooning of the foreskin during urination Paraphimosis is the result of retracting foreskin behind the glans and leaving it in that position This leads to venous congestion and edema—thus making it difficult to reduce the foreskin back to its normal position ( Fig 119.2 ) This often results after bathing (often by a provider not used to caring for the child), or is caused by the child himself In iatrogenic settings, this may occur after urethral catheterization, when the foreskin is retracted for the procedure but is not returned to its normal position