Phimosis( narrowing of the foreskin) - Causes, symptoms and treatment. MF.

Phimosis - narrowing of the foreskin opening( skin at the end of the penis), which does not allow completely expelling the glans penis.

Causes of phimosis

Nearly all healthy boys under three years of age have a physiological phimosis that is not pathology. The cause of this condition is the so-called epithelial gluing of the inner surface of the prepuce with the glans penis. Approximately to 3-6 years in norm a narrow aperture of a prepuce child's bag is stretched and it is possible to completely open the head of the penis, that is, the physiological phimosis disappears.

Physiological phimosis

Pathological phimosis is caused by anatomical narrowing of the foreskin, which is divided into congenital and pre-acquired.

Foreskin with congenital phimosis takes the form of a "proboscis."If before the onset of the spontaneous opening of the prepubic cavity the child is suffering from balanoposthitis( for example, because of the accumulation of smigma in it), the inflammation leads to scarring of the tissues of the foreskin, they become less extensible and pathological phimosis appears.

Congenital phimosis in a child

Acquired phimosis occurs as a consequence of penile diseases and may be temporary( with swelling, infiltration of the head of the penis or foreskin with inflammation or trauma) or permanent character( with development of cicatricial changes, for example, in chronic balanoposthitis).

Symptoms of phimosis

Depending on the size of the narrowing of the foramen in the foreskin, the degree of phimosis is distinguished:

At the first, most mild degree, the glans penis is easily exposed, but with an erection it takes a little effort.
At the 2 nd degree the glans penis in a quiet state opens with difficulty or effortlessly, and with an erection does not open completely.
At 3 degrees of phimosis the head does not open completely or opens only in a calm state of the penis and with considerable effort, there is no problem with urination.

Phimosis of 4 degrees leads to difficulty urinating, it is impossible to expose the glans penis, a hole in the foreskin is dotted. When urinating, the preputial sac swells, the urine is excreted outward by a thin stream or by drop. Possible acute retention of urine or the formation of preputial stones( smegmolites).

Pathological phimosis of the 4th degree

Phimosis usually attracts the attention of the patient when it causes problems with urination or is complicated by inflammation( balanitis, balanoposthitis), tumoral formations. In phimosis, the hygiene of the penis is difficult, the smugma accumulates in the prepuce cavity, and since it is a good nutrient medium for microorganisms, hence the inflammation. This is often found in preschool children, when the prepuce bag has not yet opened, and the smegma has already started to form, stagnation occurs, the penis looks swollen, which worries parents.

In addition, phimosis can cause pain in an erection due to the inability to expose the glans penis.

Complications of phimosis

When phimosis is difficult to conduct hygienic measures, stagnation of smegma occurs, on this soil inflammation( balanoposthitis) can develop, the accumulation of a large amount of smegma provokes the formation of preputial stones( smegmolites).Inflammation in phimosis is difficult to treat, with the scarring of the foreskin and phimosis aggravated, passes into the next degree.

Obstructive urination can lead to impaired emptying of the bladder and upper urinary tract with a decrease in their tone, the appearance of residual urine, which favors the development of urinary infections.

In children, phimosis in combination with balanoposthitis can cause enuresis( bedwetting), and also cause spontaneous erections, which also causes mental trauma to the child.

At the 3rd, 4th degree of phimosis, a partial or total increment of the prepuce to the mucosa of the glans penis may occur. In this case, attempts to open the head cause pain and bleeding. In this case, resort to surgery.

Long-term phimosis can be complicated by tumors of the penis due to the permanent carcinogenic effect of smegma.

Independent attempts to open the head in phimosis can lead to paraphimosis - infringement of the glans penis with extreme flesh, and with untimely medical care - to necrosis of the glans penis. The head can not be closed by the foreskin, it swells, turns blue. First aid in this case - call a doctor, apply cold, after 5 minutes try to fix the head. If failure is necessary, the incising ring should be cut.

Diagnosis of phimosis

The diagnosis is usually not difficult and is performed after external examination of the penis. To determine the cause of inflammation( if any) take a smear for analysis.

Treatment of phimosis

If the physiological phimosis persists for 3-4 years, the boy usually resorts to manual division of the foreskin and glans penis. Since the foreskin is very elastic in childhood, it allows pulling it in the proximal direction to expose the head, while the line of adhesion of the head to the inner surface of the foreskin is noticeable. If it is impossible to manually separate, they resort to a metal trigger probe, which gradually separates the head from the foreskin in a circular motion. After the procedure, the head is treated with vaseline oil, and the prepuce bag is closed to prevent paraphimosis. After medical intervention, parents should disclose the preputial cavity of the child at least once every 2-3 days according to the doctor's instructions and rinse it with a slightly pink solution of potassium permanganate or soapy water to remove smegma.

If phimosis is poorly expressed, does not cause anxiety, it makes it possible to conduct hygienic procedures - removing smegma from the preputial cavity( and this must be done regardless of the presence or absence of phimosis, and in phimosis - especially carefully), no treatment is required.

In all other cases, when the exposure of the head to the bloodless way for hygiene of the preputial cavity is not possible, only surgical intervention remains - circular circumcision( circular excision or circumcision).

When combining acute balanoposthitis with phimosis and not being able to rinse the prepuce bag, a longitudinal dissection of the prepuce is necessary to treat inflammation. After eliminating balanoposthitis, circumcision is performed.

Prevention of phimosis

There is no specific phimosis prophylaxis. Secondary prevention is careful hygiene of the penis and a timely visit to the doctor at the first signs of pathological phimosis, inflammation or trauma.

Doctor of therapeutist Naumenko ON