Phimosis

introduction

The Phimosis ( Synonym: Forehead tight) is caused by a disproportion between the width of the foreskin and the size of the Glans penis (Acorn). Because of this tightness, the foreskin can no longer be pulled back behind the glans from around the age of 2. This can lead to inflammation, pain, and complications with urination.
In addition, a foreskin that is too tight can lead to the emergency situation of paraphimosis. Here, the foreskin can no longer be pre-slipped and thus prevents the blood supply to the glans.

etiology

The prevalence is 5-7% for boys between 5 and 7 years of age. At the age of 16, around 1% of boys are still affected.

Symptoms

Symptoms of phimosis may include painful urination or a ballooning up of the foreskin (Balangitis) be urinating. The urine cannot be completely emptied, but flows behind the foreskin and causes it to swell. In addition, genital hygiene cannot be carried out thoroughly enough, so that inflammation of the glans or the foreskin can develop. These are accompanied by pain, swelling of the glans and reddening and are usually very annoying for the person concerned. It is not uncommon for the glans to turn bluish during an erection.

Read more on the topic: blue acorn

diagnosis

The phimosis is usually noticed at home by the mother or the boy himself, depending on the degree of tightness of the foreskin and the symptoms. So is also no diagnostic equipment necessary to safely diagnose phimosis. The tactile and visual findings in combination with the symptoms described are usually sufficient.

Therapeutic measures for phimosis

The only curative therapy is operative Circumcision (clipping). Under no circumstances should manual retraction be performed. Not only can this have traumatic consequences for the child, it is also painful and can lead to injuries to the foreskin. These in turn can scar and lead to a scarred phimosis.
Thus, all foreskin constrictions are surgically corrected. The foreskin can only be partially or radically removed at the parents' request.
The Circumcision is now a routine operation and can be carried out on an outpatient basis if the course is uncomplicated. The operation is usually performed between the age of 2 and school entry, provided there are no problems, pain or complications. If this is the case, the operation should be carried out as quickly as possible, regardless of age. Contraindications for surgery are infections or other genital abnormalities. In particular the hypospadias (anterior gap formation of the urethra) is a contraindication, as the foreskin is preferably used for this surgical correction in order to completely close the urethra.

Operation (OP)

Surgery for phimosis (Narrowing of the foreskin) is appropriate when after the completed 2nd year of life Complications arise from the narrowing of the plan. Such complications can include recurring infections that are made easier by the narrowing of the foreskin. You should then have one Phimoses OP think.

The surgery that comes into question is what is called Radical circumcision. The two foreskin sheets are removed in a circular manner. The operation is either in Local anesthesia or in general anesthetic carried out.
In children, general anesthesia is used, while in adults it is a so-called penis block Local anesthetic (Mepivacaine 1%) is injected subcutaneously. This is injected into the base of the penis on both sides. This exposes the penis to the sensation of pain and the operation can be performed.

As part of the operations, adhesions are then first loosened and if necessary. Then on the back (dorsal) the foreskin incised (so-called incision) and circular (circular) cut around the two foreskin sheets. This happens at the level of the so-called Coronary sulcus, the furrow under the glans of the penis. The next step is the Frenular artery prevented. This is what is called a ligature.
This artery runs in the frenulum, the foreskin ligament and serves to supply the foreskin with blood. The foreskin ligament (Frenulum) is also severed. The last step is to join the inner and outer foreskin sheets with sutures.

Another operation is the so-called plastic circumcision. This also loosens adhesions, but then only enlarges the foreskin a little.

After the operation, the surgical wound is covered with an analgesic bandage, which should be left for a few days to relieve pain.

There are seldom complications with this operation. Such complications could, however, be a wound infection or wound edge necrosis, as well as recurrent phimosis (Relapsed phimosis) especially if too much remaining foreskin was left. If meat stenosis occurs, i.e. a narrowing of the urethra (Urethral stricture), another operation may be necessary.

In general, the hygiene of the penis and the penis glans is better to maintain after such an operation and it is generally considered more hygienic when the glans is exposed.

Ointments and creams

If the phimosis is uncomplicated, i.e. there are no persistent or recurring infections and the urine flow is undisturbed, a conservative Therapy to be tried. First of all, this means that you can wait until you are 3 years old to see how it will develop further. Furthermore, ointments containing estrogen or cortisone can be used on a trial basis.
Such would be for example Ovestin (Estriol) or Dermoxin (Clobetasol) or Ecural (Mometason). These creams should be applied and rubbed under the foreskin twice a day. The whole is applied for about 4 weeks.
In about 80% of cases, this application improves the constriction.

stretch

In the case of phimosis, you can first try to stretch it gradually. Here, cortisone-containing ointments should also be used.
During the daily creaming, the foreskin is always moved carefully. However, it should be noted that this should only be possible without pain and without resistance! This effort should be carried out over a longer period of time and can achieve results that do not require further surgical therapy.

Complications

In about 1% of cases, secondary bleeding occurs in phimosis, Wound healing disorders, secondary scarring and irregular wound edges are very rare (0.05% of cases).

Another complication of phimosis is that too Penile cancer. Phimosis and the resulting poor hygiene lead to the formation of foreskin sebum, known as smegma. This smegma is a risk factor for developing penile cancer.

Other forms of phimosis

Infant phimosis: This is a fusion of the epithelium of the glans (Glans penis) with the inner foreskin epithelium. This amalgamation usually resolves in the thirdYear of life, is considered physiological and thus represents no op indication represent.
Paraphimosis: Paraphimosis is an acute emergency situation and must be treated appropriately immediately. The cause of a paraphimosis is a retraction of a too tight foreskin behind the glans into the Coronary sulcus. The penis swells because the blood supply and drainage are interrupted. In the worst case, paraphimosis can occur too Necrotizations Lead to (die off) the glans. However, due to the very severe pain, paraphimosis is usually treated in good time. Therapy is initially manual reduction in which the edematous tissue is compressed so that the foreskin can be pulled forward. If such a maneuver is not possible, the lacing ring is turned from the dorsal (back) in anesthesia incised to avoid necrotizing the penis. After the penis has decongested, circumcision is performed.

Benefits of Therapy

After a Circumcision better genital hygiene is possible so that inflammation is avoided. In addition, it has now been proven that circumcised boys have a significantly lower risk of developing penile cancer in the course of their life. Sexually transmitted diseases are also less common in men after circumcision. This is probably due to the more practicable hygiene.

Phimosis in the child / baby

First of all, phimosis just means that the foreskin does not have the penis Penis glans is to push back.

Such a phimosis is physiological at a certain age, i.e. normal and has no disease value. This is the case up to the age of 3. During this time the foreskin is with the Glans penis (Penis glans) glued. Gradually, the foreskin can then be pushed back further.
As an approximate guideline, 50% of boys have a foreskin that extends beyond their first year of life Coronary sulcus the glans penis can be pushed back. After completing the 2nd year of life, this is already possible for around 80%. Typically, after puberty is over, the foreskin should be completely detached and slidable.

Therefore, in the case of phimosis in infancy or childhood, no surgical intervention is initially necessary, as further development can be awaited.

Phimosis, however, is always pathological, i.e. with disease value, if it leads to recurring inflammation of the glans penis and / or the foreskin, if there is a congestion of urine or if there is already scarring on the foreskin due to infections. In these cases, further therapy would be advisable.

Summary

The phimosis is a relatively common one Disease picture in childhood and is now treated as a routine procedure. The only curative therapy for phimosis is circumcision of the boy. The operation is often performed in early childhood (between the ages of 2 and 6) and is usually completely uncomplicated. Forced widening or pulling back should be avoided in any case, especially to save the child from this traumatic experience.
It is important to distinguish it from infant phimosis. These are merely adhesions of the Epitheliawhich in most cases disappears after the age of 3. An emergency indication, on the other hand, is paraphimosis, which is associated with the risk of necrosis and very severe pain and therefore requires immediate treatment.