Kayaba et al classified prepuce types in Japanese boys. The authors are from Fujiwara Memorial Hospital and Akita University School of Medicine in Akita, Japan.
Parameters:
(1) retractability of prepuce
(2) presence or absence of a tight ring
Retractability of Prepuce
Type
none at all (no portion of glans visible)
I
only urethral meatus visible
II
glans exposure up to halfway to the sulcus of corona
III
glans exposure to just above corona (does not reach sulcus)
IV
complete exposure of entire glans
V
where:
• Pinhole prepuce (variant of Type I) is the most severe form of unretractable prepuce.
The second feature is the presence or absence of a tight ring. The location of the tight ring affects the retractability type. For example, the presence of a ring in the distal prepuce favors a Type I or II pattern.
The authors noted that separation of the prepuce may not be complete until adolesence, and tight rings are common in infants and young children. These findings should not be used as reasons to perform a circumcision in an asymptomatic boy.
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