General Anesthesia pada Tindakan Sirkumsisi Pasien Phimosis dengan Sindrom Nefrotik

Abstract

Pathological phimosis is a condition characterized by the inability to retract the prepuce due to fibrotic narrowing, often presenting with dysuria, recurrent infections, or urinary obstruction, and requiring circumcision as definitive treatment. The presence of nephrotic syndrome as a comorbidity increases the complexity of perioperative anesthetic management because of potential hypoalbuminemia, altered pharmacokinetics of anesthetic agents, and the risk of perioperative complications. This case report describes a 12-year-old boy with pathological phimosis and nephrotic syndrome in remission who presented with difficulty retracting the foreskin, painful urination, and low-grade fever. Physical examination revealed a non-retractile prepuce without signs of paraphimosis or active infection. Laboratory investigations demonstrated mild leukocytosis, serum albumin of 2.8 g/dL, and proteinuria (2+), consistent with nephrotic syndrome in remission. The patient was classified as American Society of Anesthesiologists (ASA) physical status II and underwent elective circumcision under general anesthesia with endotracheal intubation. Anesthesia was induced with fentanyl and propofol and maintained with sevoflurane. The intraoperative and postoperative courses were uneventful, with stable hemodynamic parameters and satisfactory recovery. This case highlights that elective circumcision under general anesthesia can be performed safely in pediatric patients with nephrotic syndrome in remission through comprehensive preoperative assessment, appropriate anesthetic selection, careful perioperative fluid management, and multidisciplinary collaboration.