urology Phimosis

Phimosis is a condition in which the foreskin is too tight to pull all the way back. Phimosis is normal in all baby boys and may be present for some years, until the foreskin has become supple enough and stretched enough to be pulled back, so that the head of the penis may be seen

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completely. In some cases, there may be tight  foreskin which may result in a permanent phimosis.  Some time  scarring may be caused by infection or inflammation of the foreskin, or forced stretching of the foreskin causing splitting, before it is ready to be stretched. Approximately 10% of boys develop scarring with phimosis.

Symptoms of phimosis

Common symptoms of phimosis include:

  • Bulging of the foreskin
  • Difficulty urinating
  • Inability to pull back the foreskin
  • Pain and itching of the tip of the penis.
  • Swelling of the tip of the penis

Causes  of Phimosis

Phimosis is congenital . It is physiological till the age of 1 year. Phimosis typically improves and resolves itself after  age of 1 year. . Not all boys and men with risk factors will get phimosis. May be scaring of the fore skin leads to phimosis.

How is phimosis treated?

Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. If phimosis in older children or adults is not causing acute and severe problems, or if the phimosis is mild, nonsurgical measures may be effective. But all the phimosis which are too tight and ones which are failed conservative treatment  needs to be treated surgically.

Non surgical methods

Application of topical steroid cream, such as betamethasone, for 4–6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective. It has replaced circumcision as the preferred treatment method for some physicians.

Stretching of the foreskin can be accomplished manually, with balloons or with other tools. Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out at home while giving bath to kids.. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction

Surgical methods

Surgical methods range from the complete removal of the foreskin to more minor operations to relieve foreskin tightness:

  • Circumcision is sometimes performed for pathological phimosis, and is effective.
  • Dorsal slit (superincision) is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.
  • Frenuloplasty; is done for the short frenulum which prevents the prepuce retraction. Frenulum is cut horizontally and sutured vertically.
  • Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin can be an effective alternative to circumcision. It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects.

What are the potential complications of phimosis?

Complications of untreated phimosis can be serious,. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of phimosis include:

  • Recurrent Urinary tract infection
  • Difficulty ejaculating
  • Difficulty urinating
  • Infertility
  • Cancer penis: Phimosis left for many years in to adult hood can result in cancer penis.

So all phimosis needs to be treated. Simple surgery can prevent some dangerous complications.

Authored By : Dr. Mahendra Jain

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Dr. Mahendra Jain

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