Contents
Phimosis means a narrowing in the area of the foreskin, which to some extent prevents the head from being exposed. This condition occurs in 2-3% of adult men.
Causes of phimosis
In 96% of male newborns, physiological phimosis is detected, caused by natural adhesive formations between the surface of the head and the foreskin. In addition, in most babies, the internal opening of the preputial sac (cavities under the foreskin) is very small and does not allow the head to be released. Physiological phimosis gradually disappears in the period up to 18 years. At the same time, the majority disappears by the age of 7. However, complete separation of surfaces can occur later, most likely during adolescence, during puberty. A significant narrowing can cause the development of complications – balanoposthitis, cicatricial changes, etc. As a result, the physiological form becomes pathological. This condition is called congenital phimosis.
In adult men with a properly formed foreskin, cicatricial phimosis can form due to a number of diseases. Causes of phimosis: • diseases o balanoposthitis – an inflammatory lesion of the foreskin with a head, manifested by itching, burning, pain, redness, cloudy discharge; o cavernitis – an inflammatory lesion of the cavernous body of the penis; o lichen sclerosus – a chronic pathology with focal atrophy of the skin and mucous membranes, manifested by the formation of white shiny plaques; o genital infections (phimosis is a common symptom of primary syphilis, can develop with genital herpes); o genital allergy (to insect bites, condom material, etc.); • injury to the flesh in boys during the forced removal of the head; • urethral catheterization; • insufficient hygiene, etc.
Contributes to the appearance of a cicatricial form of uncompensated diabetes, especially in combination with urogenital candidiasis (fungal disease).
Symptoms, complications
In the physiological form, the skin of the foreskin is healthy, has no cicatricial changes and is easily pulled out with slight tension. In pathological phimosis, gentle tension results in the formation of a cone-shaped structure with a narrowed dense white end. Such differences make it possible to differentiate physiological and disease states.
There are 4 degrees of severity of phimosis: • I – it is possible to release the head at rest, with an erection difficult; • II – difficult to release in any condition; • III – release is possible episodically; • IV – the head is never released.
The main complaints of patients include: • the actual impossibility of removing the head; • painful manifestations during erection, sexual intercourse; • pain when urinating; • appearance of blood in the urine; • the formation of cracks in the foreskin, bleeding; • violations of urination (weak, intermittent jet, inflation of the skin of the penis, etc.); • recurrent balanitis, balanoposthitis due to infection of the accumulating smegma.
Pain, infections, urination disorders are not typical for the physiological form. A long-term condition of any form can lead to: • paraphimosis – a pathology in which the foreskin “gets stuck” behind the head and cannot close the latter (requires emergency medical care due to the risk of circulatory disorders and necrosis); • chronic balanoposthitis; • difficulty urinating up to delay; • cystitis – an inflammatory disease of the bladder; • the formation of kidney stones; • pyelonephritis – inflammatory renal pathology, etc.
According to some reports, pronounced phimosis with a prolonged course may be a risk factor for developing penile cancer.
The diagnosis is established on the basis of the complaints presented to the patient and the results of the examination. If infections of the genitourinary tract and / or skin are detected, a laboratory study may be required.
Phimosis treatment
Treatment of phimosis is determined by the form of the disease, age, severity of the problem, the causes of the condition and concomitant disorders.
In the physiological form, treatment tactics are reduced to dynamic observation. Careful hygiene of the genital organs is required, washing with warm water with light tension on the foreskin, avoiding the use of strong detergents. Some doctors recommend stretching with Vaseline in this form. It is important to avoid rough manipulations leading to ruptures in the area of the external opening and the development of a scar form.
As a remedy, corticosteroid ointments can be used to prevent scarring. Data on the effectiveness of the use of such funds range from 65% to 95%. The mechanism of action of steroid therapy has not been precisely established. It is assumed that such drugs have a local anti-inflammatory and immunosuppressive (immune depressant) effect, cause thinning of the skin, reduce the growth of the skin. Preparations with 0,05% betamethasone, applied twice a day for 4 weeks, showed high efficiency. The greatest efficiency was observed in the group of older boys. Clobetasol, mometasone, etc. preparations can also be used. The success of treatment depends on the age of the patient, the type and severity of the pathology, and the regularity of using the remedy. Rare side effects include mild soreness and redness in the foreskin area. Significant undesirable manifestations are not noted. This is why topical (topical) steroids are recommended as the first line of treatment for pathologic phimosis.
As measures of conservative therapy can also act: • non-steroidal anti-inflammatory ointment with sodium diclofenac three times a day (75% more effective than petroleum jelly); • estrogen-containing ointments; • local antibacterial and antifungal agents, in the presence of concomitant balanitis/balanoposthitis, depending on the cause of the condition; • adequate control of glucose levels in diabetes mellitus.
In children without cicatricial changes and infection on an outpatient basis with local anesthesia, soft separation of adhesions using a balloon catheter can also be performed. The cicatricial form, forms with a complicated course are absolute indications for surgical intervention, as a rule, excision of the foreskin circular, the so-called. circulation. This procedure is also carried out for religious and cosmetic reasons. In children with genital anomalies, such an intervention is not recommended (flesh tissue may be required in the future when performing surgical correction of the anomaly).
An operation is possible with the preservation of the foreskin, involving only an increase in the diameter of the external opening, preputioplasty. The intervention can be performed on an outpatient basis, low-traumatic, short in time, accompanied by minor cosmetic changes.