Writing in the December issue of BJU International, Dr Joe Philip and his colleagues at Leighton Hospital, Crewe, report on four boys under the age of four, who were admitted with injuries serious enough to require an overnight stay.

"As Christmas approaches many families will be visiting relatives and friends and their recently toilet trained toddlers will be keen to show how grown up they are by going to the toilet on their own" he says.

"It is important that parents check out the toilet seats in advance, not to mention the ones they have in their own homes, and accompany their children if necessary.

"A recent market research report has suggested that there has been a worldwide increase in the number of wooden and ceramic toilet seats sold. We would not be surprised to hear that other colleagues have noticed an increase in penis crush injuries as a result of this."

The four boys, aged from two to four, all attended as urological emergencies.
All had been recently toilet trained and they were using the toilet on their own. They had lifted the toilet seats, which had then fallen back down, crushing their penises.

Three had a build up of fluid in their foreskin, but were still able to pass urine, and the fourth had glanular tenderness.

Luckily there were no urethal injuries or bleeding and the symptoms settled down with pain relief. All the children were able to go home the next day.

The authors have come up with four key recommendations:

1. Parents should consider fitting toilet seats that fall slowly and with reduced momentum, markedly reducing the risk and degree of injury.
2. Heavier toilet seats could be banned in houses with male infants.
3. Households with male infants should consider leaving the toilet seat up after use, even though it contradicts the social norm of putting it down.
4. Parents could educate their toddlers to hold the toilet seat up with one hand when they pass urine and keep an eye on them until they are confident that they are able to do it unsupervised.

"As any parent knows, toilet training can be a difficult time with any toddler" concludes Dr Philip. "We are concerned that the growing trend of heavy toilet seats poses a risk not only to their health, but to their confidence."

Source: Wiley