Phimosis - causes
The content of the article
Depending on what causes phimosis, there are two types:
- Physiological, congenital or primary - present from birth (in some children it occurs soon after birth, but in others much later in childhood), spontaneous onset, natural protection of the head from exposure to ammonia from urine, usually disappears by 3 years or later in adolescence .
- Acquired, pathological or secondary - pronounced narrowing of the foreskin. It cannot be retracted even when separated from the glans penis, due to inflammation or damage to the skin of the penis, incomplete circumcision and some skin diseases. Requires treatment.
One day - and everything is in order!
Circumcisio
- Cost: 45,000 - 65,000 rubles.
- Duration: 30-60 minutes
- Hospitalization: 1 day in hospital
More details
The most effective treatment for phimosis is circumcision. During this operation, the foreskin is removed completely or partially, as a result of which there are no more problems with exposing the head of the penis. Of course, our Center performs operations for phimosis. Our patients often ask how difficult this operation is. The question of the complexity of any operation is not easy for any doctor, since there are no “easy” operations. Each surgical intervention is a responsibility for human health, so we approach all operations as complex. However, if we consider that we have been treating phimosis for a very long time, we can say that we have worked out circumcision to a sufficient extent. The technique of circumcision surgery is relatively simple, and therefore the risk of developing postoperative complications is reduced to almost zero. As for further postoperative stay, the patient (if desired) can either stay in the hospital for a day, or the operation can be performed on an outpatient basis - in the morning he comes for the operation and in the evening he goes home. As a rule, after 2 weeks a man can live a full life.
Phimosis in boys
The role of physiological phimosis is very important during the period when the child is in diapers. Because stool bacteria react with urine and produce ammonia. This can lead to infection of the glans penis and diaper rash.
At birth, the foreskin is connected to the head of the penis, and this is a completely normal (physiological) phenomenon. As the child grows, spontaneous separation of the foreskin from the head of the penis occurs.
In boys, you can also try to stretch the foreskin by pulling backwards. The most practical way to do this is after bathing using a special cream. At this moment the skin is most elastic.
At this point, smegma may appear - whitish-yellowish accumulations under the foreskin of the penis. These are dead cells connecting the foreskin to the skin of the glans. They can be removed while bathing with water or baby oil.
Treatment in children
Under the age of 3 years, the disease does not pose any danger, but requires observation by a specialist and examination by a surgeon. If there is a threat of fusion of the foreskin with the head, manipulation of their separation is performed with local anesthesia. If, as the patient grows older, the problem does not go away and phimosis becomes pathological, surgical intervention to excise a narrow part of the foreskin is indicated. The decision is made by the urologist together with the surgeon if there is a threat of disruption of the urination process and possible complications in the intimate area.
Paraphimosis
Paraphimosis most often occurs when cleaning the glans penis. This is squeezing the head of the penis, slightly pushed back, by its foreskin. In no case is it recommended to forcefully pull out the foreskin, because paraphimosis may occur. This can lead to an inability to circulate through the head, bleeding, infection and scarring, all of which are accompanied by severe pain.
If this happens, professional help will be needed to restore the reduction.
Firm circular pressure with your hand on the head of the penis can reduce the edema (swelling) so that the foreskin changes position. If this fails, an incision is made under local anesthesia, temporarily solving the problem. After the swelling has subsided, they resort to circumcision.
Phimosis - symptoms and treatment
Non-drug treatment
Physiological phimosis can be eliminated without surgical treatment . [4] The most acceptable method is gradual gentle stretching of the foreskin. Treatment of phimosis in children can be carried out starting from six months.
The elimination of phimosis using a bloodless method based on two principles.[7]
The first principle is a slow impact on the narrowed cavity of the foreskin. Treatment is carried out in stages and can last from 3-5 months to several years. During such events, the head of the penis ideally opens by the beginning of puberty, i.e. by 12-15 years. These dates are due to hormonal changes in the boy’s body.
The second principle is the most gentle stretching of the foreskin, in which even minimal injuries (tears, cracks) of the narrowed area are unacceptable. Each procedure is designed to dynamically open the foreskin cavity by 1-2 mm from the initial state. In order to improve the stretching of the flesh, before the procedure the patient should lie for 10-15 minutes in a bath with decoctions of chamomile, string, celandine or calendula. Thanks to this, the skin is steamed, stretches easier and is less injured. After the bath, stretching manipulations should be performed for at least 15 minutes. Then the foreskin should be treated with baby cream, levomekol, ELMA ointment 5% or solcoseryl - they help heal any microtears that arise. At the end of the procedure, the child should lie on his back for several minutes without diapers or underwear.
Initially, these procedures are performed by a doctor, who is obliged to show the technique of such manipulations to the parents. In the future, treatment comes down to the parents' daily compliance with the doctor's recommendations and medical monitoring of the dynamics of the process of displacement of the foreskin once every 3-6 months.
These principles are a very effective way to treat physiological phimosis. Thanks to them, the head of the penis opens halfway after 2-3 months in 91% of cases. In general, the success of treatment using this method depends on how regularly the procedures are carried out.
Also, in the treatment of phimosis, rings and bandages , which stretch the foreskin and fix its shape.[10]
Drug therapy
This treatment method involves regular and long-term use of corticosteroid ointments. They are applied to the foreskin and glans penis to increase the elasticity of the tissue and improve its stretchability.
Also, for phimosis, taking glucocorticoids is indicated. They are designed to reduce swelling and inflammation, accelerate the healing of microcracks, and suppress the activity of connective tissue formation.
The most effective ointments to combat phimosis are clobetasol 0.05%, betamethasone 0.05%, prednitop 0.25%, gel 2.5%.
Physiotherapy
Physiotherapeutic treatment methods include:[11]
- Phonophoresis is a painless injection of drugs into the deep layers of the skin using ultrasound. In case of phimosis, anandrogen-containing oil preparations are applied to the external opening of the foreskin. The exposure is carried out using a labile technique with a radiation frequency of 880 Hz, a working surface of 0.5 cm2, an intensity of 0.4 W/cm2 and a continuous mode of ultrasonic vibrations. The duration of the procedure is six minutes. They are carried out every other day for 1-2 weeks. This method provides effective treatment of the disease.
- Using a button probe to gradually gently stretch the foreskin. It is used in conjunction with 2.5% dihydrotestosterone gel and allows you to separate synechiae. This procedure is carried out twice a week after hygienic baths with decoctions of medicinal herbs.
Surgical treatment
Circular excision of the foreskin is indicated in cases of cicatricial phimosis. In this case, the foreskin can be removed partially (excision along the border of fibrous changes) or completely - partial or complete circumcision. In children it is performed under general anesthesia, and in adults under local anesthesia.[6] Complications after circumcision are rare. Sometimes bruising occurs on the penis, but this goes away over time.[12]
Other methods of foreskin plastic surgery:
- Prepucioplasty is performed for phimosis in adolescents with minor cicatricial changes in the skin fold. During the operation, a longitudinal incision is made along the upper part of the penis and adhesions are removed, then the wound is sutured.
- Surgical treatment with clamps is performed in children. Use Mogen clamps or disposable Plastibel clamps. Disposable clamps are placed on the head of the penis after a small incision, fixed and left for a week. No stitches are needed. The Mogen clamp is applied for 1-5 minutes and removed after cutting off the skin.
Laser treatment of phimosis
This method of treating phimosis is called the photodestructive method. Using a laser, the doctor excises and removes the abnormal tissue. The beam aimed at the flesh has a temperature of up to 300 ℃. Once on the fabric, it evaporates, or vaporizes.
The operation lasts approximately 20 minutes, including the procedure itself, preparation of documents and discharge. The laser beam quickly seals the vessels, without damaging the tissues and preventing blood loss.
Treatment of phimosis with traditional methods
The effectiveness and safety of traditional methods has not been scientifically proven. Phimosis often goes away on its own with age, which reinforces misconceptions about the effectiveness of alternative medicine.
Rehabilitation
After the operation you will need:
- Maintaining cleanliness - proper care will help avoid inflammation and suppuration. The treatment site can be treated with antiseptics: chlorhexidine and miramistin. Baths with potassium salt of permanganic acid are also useful.
- Monitoring by the attending physician - if inflammation, suppuration and pain occur, you should consult a doctor.
- Rest - during the first 2-3 days, it is advisable to lie down more often, as this increases the outflow of blood from the penis and reduces the development of tissue edema.
- Strict adherence to the dressing schedule established by the attending physician. After circumcision, bandages are applied to the penis, which are worn all the time until the penis heals, and are changed periodically. To wash the penis with warm and soapy water, the first change of bandages is carried out after 48 hours.
- Local treatment with antibacterial ointments. To avoid suppuration, your doctor may recommend using antibacterial ointments, such as Levomekol and Levomethyl.
- It is important to ensure that the child does not touch the wounds with his hands. Instead of water procedures, it is better for the boy to be rubbed down until complete healing.
- It is not recommended to wash the penis for 7 days until the stitches are removed. To avoid getting the wound wet while showering, you should wear a condom on the penis. It is also important to ensure that urine does not come into contact with the wound, otherwise inflammation may develop and the wound will heal more slowly.
- Comfortable underwear. If the foreskin is removed on a small child, then the best option would be thick panties so that he does not touch his penis during play. An adult man should wear loose underwear that does not restrict movement.
- Until complete healing, abstinence from sexual activity will be required.
Phimosis – Beaugé technique
For children during puberty and adult men, another conservative (non-invasive) treatment method is used - the God technique.
The meaning of the method is stretching the foreskin. If the skin is regularly stretched for a long time, it reacts to the irritant by cell proliferation or stretching.
You need to stretch the foreskin of the penis through masturbation as often as possible (sexual masturbation).
At the same time, a corticosteroid cream is used. It provides greater elasticity to the foreskin.
Lifebuoy in the “sea” of information
Nowadays, despite the general availability of medical information, phimosis is still a fairly widespread pathology, primarily because it is not given due attention. On the other hand, quite a lot of different information has now appeared on radio, television, and the Internet. Whatever treatment methods are offered, however, the effectiveness of many of them raises some doubts. In this article we will talk about what phimosis is, what are the causes of its occurrence, the degree of development, and treatment methods.
Phimosis – surgery
In the most severe cases, surgery is required. It comes in two types:
- Circumcision is the complete resection (removal) by surgery of the narrowed foreskin of the penis covering the glans. Absorbable sutures are placed between the skin and mucous membranes. The procedure lasts from half an hour to an hour. It is performed under local anesthesia. Recovery takes about 10 days.
- Preputioplasty – partial resection. The opening of the foreskin of the penis is surgically expanded to the required size while preserving the foreskin. This leads to faster recovery.
Answers to frequently asked questions
Do they take you into the army with phimosis?
Phimosis is not an indication for medical exemption from military service. Especially if the disease proceeds without complications and does not cause inflammation of the urinary tract and penile tissue. If the patient’s pathology has signs of a complex fourth stage, preliminary surgery is possible. Based on its results, a decision is made on conscription or sending the conscript to alternative service.
How to treat phimosis?
Treatment of phimosis at home is strictly not recommended, because there is a possibility of skin injury, impaired blood flow, swelling and the development of an inflammatory process. Before using pharmaceutical drugs or traditional medicine, you should obtain a doctor’s advice and undergo an examination for possible inflammation of the tissues and urinary tract.
Is it possible to live with phimosis?
Phimosis is considered safe only for young and adolescent patients. In adults, it can cause the development of side effects, including tissue infection and inflammation in the area of the head and foreskin. Therefore, even with mild symptoms, it is worth consulting with a specialist and taking measures to prevent the progression of the disease.
