Physiological and pathological phimosis
In newborn boys, the inner layer of the foreskin is fused with the head - this is a protective mechanism. As the fusion grows, it gradually separates on its own, and the head becomes mobile. This process is individual and can take years.
Therefore, the inability to expose the head in a young child in the absence of complaints is not a disease and does not require treatment, much less forced separation of the foreskin - it leads to tears, scars and turns a physiological condition into a pathological one.
Pathological phimosis is indicated when narrowing persists in adolescents and adults, in the presence of a scar ring, difficulty urinating, pain during erection or recurring inflammation.
Degrees of phimosis
- First - the head is exposed freely in a calm state, but with difficulty during an erection
- Second - the head is exposed with effort in a calm state, during an erection it is not exposed
- Third - the head is partially exposed and with difficulty or not exposed at all, urination is not impaired
- Fourth - the head is not exposed, urination is difficult: urine comes out in a thin stream, the foreskin swells
Reasons
- Congenital narrowness of the foreskin, preserved after childhood
- Scarring after repeated balanoposthitis
- Forced removal of the foreskin in childhood with the formation of microtears and scars
- Penile injuries
- Diabetes mellitus is a common cause of sudden onset phimosis in adults due to persistent inflammation
- Lichen sclerosus is a chronic skin disease that produces dense scar tissue.
- Age-related changes in skin elasticity
- Chronic sexually transmitted infections
Symptoms and complications
- Impossibility or difficulty in exposing the head
- Pain during erection and sexual intercourse, feeling of tension
- Difficulty urinating, swelling of the foreskin, thin stream
- Accumulation of smegma and unpleasant odor
- Recurrent inflammation of the glans and foreskin
- Microtears and cracks in the foreskin during attempts at exposure
- Formation of a dense whitish scar ring
- Paraphimosis - pinching of the head by the narrow foreskin pushed back
- Difficulty in sexual activity and decreased sensitivity
- Chronic inflammation as a risk factor for penile cancer
Paraphimosis: an emergency
Paraphimosis occurs when the narrowed foreskin can be moved behind the head, but cannot be returned back. The ring compresses the head, the outflow of blood and lymph is disrupted, the swelling quickly increases and makes reduction more and more difficult.
- Немедленно обратиться за медицинской помощью — счёт идёт на часы
- До обращения можно приложить холод, чтобы уменьшить отёк
- Не пытаться силой вправить головку без обезболивания при выраженном отёке
- В clinicsе выполняется ручное вправление после обезболивания, а при неудаче — рассечение ущемляющего кольца
- После купирования эпизода обычно рекомендуется плановое обрезание, поскольку риск повторения высок
Treatment
- Observation - with physiological phimosis in children without complaints
- Local corticosteroid ointments combined with gentle gradual stretching are effective for non-scarring phimosis, more often in children and adolescents
- Maintaining hygiene and treating concomitant balanoposthitis
- Compensation for diabetes is a prerequisite for the success of any treatment
- Circumcision (circumcision) - complete or partial removal of the foreskin; the main method for cicatricial phimosis, recurrent inflammation and paraphimosis in history
- Plastic surgery with preservation of the foreskin is possible in some cases with limited narrowing
- Emergency dissection of the pinching ring in case of paraphimosis
About the operation: what is important to know
- Circumcision is usually performed on an outpatient basis under local anesthesia, in children - more often under general anesthesia.
- The duration of the intervention is short, the patient goes home the same day
- In the first days, swelling and moderate pain are possible
- Sexual rest and limitation of exercise for a period determined by the surgeon
- Complete healing takes several weeks
- Hygiene after surgery is greatly simplified
- The effect on sensitivity is discussed individually: as a rule, there is no significant deterioration in the quality of sexual life
Where is phimosis treated in Tashkent
Treatment requires an appointment with a urologist or andrologist, and if indicated, an outpatient operating room to perform circumcision.
In Tashkent, consultation and surgical treatment of phimosis is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Do not try to solve the problem by forceful stretching: this is the main reason for the transformation of moderate narrowing into dense cicatricial phimosis. Clinic contacts and online registration are below on the page.
