Phimosis (from the Greek. phimosis - tightening of the compression) – this is a narrowing of the foreskin, preventing the removal of the glans penis. This state is the norm for the young representatives of the stronger sex, however, becomes a pathology, pausing after the time was over. Let's try to understand where the border between these States.
To clearly imagine the problem of phimosis, recall the peculiarities of the anatomical structure of the prepuce "male dignity."
The penis (the penis) consists of body, head, and root. The head of the penis hidden behind the skin of the foreskin (prepuce), which in an adult male is easily displaced, exposing the head. The foreskin consists of two leaves: the outer, which is not different from most other skin areas of the body and interior, soft and smooth, resembling mucous membrane. Between the head and the inner leaf of the foreskin has preputial space (sometimes called the preputial SAC). In this cavity stands out the secret of the glands under the foreskin and form a special lubricant (smegma), which facilitates the sliding of the head. On the lower surface of the penis foreskin is connected to the head by the frenulum of the prepuce is a skin fold, in which the vessels and nerves. On the head there is the external opening of the urethra.
Newborns of the knights of the glans is the prepuce adherent to a kind of spikes that do not allow you to freely withdraw the head. This physiological feature - a kind of protective mechanism to reduce the probability of infection in the preputial space and the development of inflammation - called physiological phimosis. For boys 3-7 years with physiological phimosis is a perfectly normal condition! Statistics show that at the age of 1 year, the head of the penis opens at 50 % of boys and by 3 years - is already at 89 %. The frequency of phimosis in 6-7-year-olds is 8 %, and 16-18-year-old boys - only 1 %.
The growth of the head member gradually pushes the prepuce, the physiological sinehii destroyed. Well, in puberty, starting from 12-14 years old when aktiviziruyutsya male sex hormones that make the tissue of the foreskin more elastic and stretchable head opens fully.
Physiological phimosis does not require any treatment, but requires parents to pay close attention to the condition of the external genitalia of the child. The condition of the glans penis, the prepuce and preputial SAC (the space) is easiest to control during daily cleaning, and when the child urinates. If the foreskin is swollen and reddened, and the child and then stretches hand a causal place (and even more so in the case if difficult urination), it is urgent to consult with children's services, and if such a specialist does not have a pediatric surgeon or urologist.
About phimosis as a medical diagnosis (i.e., pathological narrowing of the prepuce) begin to speak in the case when to bring the head of the penis cannot the boy after 6-7 years.
Phimosis, depending on the condition of the prepuce may be atrophic and hypertrophic. In atrophic phimosis skin of the foreskin is very thin and extremely susceptible to microtrauma, resulting in the formation of scars. In hypertrophic, the prepuce, on the contrary, quite thick, and "proboscis" speaks far beyond the boundaries of the glans penis.
In addition, phimosis, to distinguish between degrees. Depending on the severity of the narrowing of the foreskin, there are 4 degrees of phimosis:
- 1 degree. In a calm (relaxed) state, the head of the penis exposed without problems, but during erection it requires a little effort.
- 2 the degree. During erection head does not open at all, calm with an effort.
- 3 degree. The head of the penis does not open at all, or possible only with considerable effort and only in a calm state of the penis, but problems with urination phimosis causes.
- 4 the degree. When urinating at first swells preputial bag, and then piss (trickle or dropwise) stands out. The head of the penis cannot even reveal.
The main causes of phimosis are:
- Genetic predisposition to the formation of phimosis in the result of insufficiency of elastic component of connective tissue in the body;
- Penile trauma, which resulted in the formation of scar tissue leading to narrowing of the foreskin;
- Inflammation of the foreskin of the penis also lead to cicatricial changes.
It should also be noted that the phimosis is a factor of the further narrowing of the foreskin. The fact that the presence of even a slight contraction is a constant injury of the sheets of the foreskin when the exposure head. This situation is especially common in puberty and the emergence of erections. During erection increases the size of the head and body of the penis, which causes the tension of the foreskin and the formation in it of the micro-gaps. In the process of healing in the field of micro-gaps is formed in scar tissue are not able to tension, which leads to the progression of phimosis.
What is dangerous phimosis
Since the phimosis is somewhat difficult to hygiene, if not careful care of the baby possible stagnation of smegma. Unfortunately, it is the perfect breeding ground for bacteria, which in turn can cause the development of inflammatory processes. Moreover, with long-term stagnation is even possible the formation of dense formations - smegmatis (literally, "smegma stones").
Especially dangerous is phimosis 4-th degree, in which there are barriers to the outflow of urine. Increased pressure in the preputial sack at the end of urination, when the reduced pressure in the bladder, leads to a backflow of urine and dissolved smegma urethra. This leads to the development of infectious complications in the urethra.
Complications of phimosis
Generally speaking, the main danger is not the phimosis and its complications. The most formidable of these is paraphimosis - infringement glans narrowed foreskin by forced it open. This can happen when the family or the child that is called "got game" - exposed the head, and return the foreskin in place are unable. Paraphimosis can also happen at a later age, during intercourse or Masturbation. Infringement leads to swelling of the penis head that at a certain stage makes the reverse reduction is impossible. As a result of violations of blood circulation head turns blue, and becomes sharply painful. And if not to provide emergency assistance, there may be a necrosis (necrosis) of the head, which leads to its amputation.
As you know, to assist in this case can only be a specialist. Immediately call an ambulance. Procrastination as an attempt to cope with this problem by yourself, is fraught with the loss of precious time and severe consequences.
Dangerous complication of phimosis can be balanoposthitis - inflammation of the foreskin and the glans of the penis. It develops when poor cleanliness of the genital organs and infection of the preputial space. The chance of developing balanoposthitis increases in children with reduced immunity or against other infectious diseases. Inflammation of the foreskin it is characterized by swelling, redness (hyperemia), pain, purulent secretions from preputial space. The result of the inflammation may become cicatricial degeneration of the skin of the foreskin and, as a consequence, the further development of phimosis. Balanoposthitis is a disease that require urgent medical care. The doctor inserts a special probe between the glans penis and skin of the foreskin, which neatly divided the available sinehii, thereby creating conditions for the outflow of the accumulated pus.
Another complication of phimosis requiring immediate treatment to the doctor with acute urinary retention. This condition is more common in young children and is reflex in nature, as a reaction to the pain. The child for a long time could not urinate, becomes restless, complains of pain in the stomach and above the vagina, where palpable enlarged bladder. In the treatment process, the baby is given pain medication, do a cleansing enema (to the intestines full of feces, not further pressed, and does not hinder the flow of urine), and then do a warm bath with potassium permanganate, during which the child tries to urinate. If that doesn't work, the urine passes through the catheter.
The complication of phimosis grade 3 and 4 may also be the increment of the foreskin to the head. Usually first grows in this small area, then the area of the seam widens and eventually the foreskin adheres to the glans penis in its entirety. In this case, attempts to open the head accompanied by sharp pain and bleeding. This condition is not an emergency, but to run it is not worth it. When the increment of the foreskin is only possible surgical treatment. But, as with a large plot of fusion intervention can be difficult, the sooner the problem is discovered, the easier it is to resolve.
Treatment of phimosis
In the treatment of phimosis can apply both conservative and surgical methods.
Conservative treatment of phimosis
In hypertrophic phimosis, if there are no complications, possible conservative treatment, which consists in the gradual stretching of the foreskin. Manipulation can be performed by parents at home. Three times a week while bathing with decoctions of herbs (succession, daisies) is the displacement of the foreskin until the child's pain, and then in the preputial space is introduced a few drops of sterile paraffin oil. The treatment duration - some months. Procedure should be performed very carefully to avoid paraphimosis. Success depends on perseverance of the parents and the severity of phimosis.
In recent years, used the correction of phimosis hormonal ointments that lay in the preputial space. They facilitate the stretch of the fabric. The treatment is carried out by parents under the mandatory supervision of a physician.
In atrophic (scar) phimosis conservative treatment is not effective. In this case, surgical methods are used.
Surgical treatment of phimosis
Indications for surgery are the paraphimosis expressed cicatricial changes prepuce, of repeated recurrence of balanoposthitis, a violation of urination.
The fastest and most effective treatment of phimosis - an operation called circumcision, or circumcision. The procedure the foreskin is removed, which eliminates any exposure of the glans penis. This operation takes 10-15 minutes and is usually performed under General anesthesia. The foreskin is cut circularly (circles), with preservation of the frenulum. The inner and outer sheets of the foreskin is sewn together with catgut (suture material, which further does not require removal of sutures, as self-absorbed). After surgery, a bandage with vaseline oil. A few hours after the surgery, the child can walk, restored self urination. Circumcision is indicated for any degree of phimosis.
Contraindications for circumcision are balanoposthitis and paraphimosis.
Longitudinal cut of the foreskin
This operation is used if a full circumcision is impossible. As a rule, to its treatment with two types of complications of phimosis with acute balanoposthitis and paraphimosis. In the first case, the longitudinal slit of the foreskin is resorted to due to the fact that the opening of the inflammation of the glans penis impossible to trim, as the infection can lead to insolvency seams. Well, paraphimosis, if an acute violation of blood circulation does not allow for a full circumcision, a longitudinal incision of the foreskin is the only way to "breed" ring, compressing the glans penis.
By the way, in either case, after the acute period (it means when the worst is behind us), the doctor may recommend to crop, which would have been not medicinal, and cosmetic value.
Prevention of phimosis
Development of phimosis is largely due to genetic predisposition, so drastic measures of prevention of this disease medicine can offer. But we can talk about prevention of complications of phimosis. Here, the first and main role is played by hygiene.
Infancy proper hygiene care limited daily bathing of child and washing once baby's soiled diaper or diapers. While bathing under the foreskin enters the water, which naturally flushes out the accumulated secret. At least once a week you should wash the penis and scrotum with soap and water. It is better to use baby soap or special baby bathing facilities. Not recommended daily use of antibacterial Soaps or gels. With frequent use they can upset the balance of normal microbial environment necessary for healthy skin.