What is phimosis: surgery and treatment at home
Men’s reproductive organ disease when the glans penis opens painfully or does not open at all due to narrowing of the foreskin. Almost all newborn boys have an inelastic foreskin, but by the age of three only 10% of children suffer from this pathology. The norm is considered by doctors to be the disappearance of phimosis by school age. In the adult state, such a disease is a consequence of pathological changes and requires a mandatory visit to a urologist in St. Petersburg.
How is phimosis classified?
Quite simply, depending on the degree of extension of the foreskin and on how well the head of the reproductive organ opens, there are four degrees of phimosis:
First - the foreskin requires little effort to release the head only with an erection.
The second - the foreskin requires a little effort in the free state, with an erection the head remains closed.
Third - to open the head, you should make sufficient effort even in a free state. During an erection, the head is closed, there are no problems with the outflow of urine.
Fourth - the head of the penis remains closed in any condition, when going to the toilet, problems with urination.
If you want to visit a doctor in a timely manner and do not want to start the disease, you need to know the main symptoms of phimosis. It manifests itself equally in men at any age: it is impossible to free the head of the penis. This causes discomfort and pain in men during intercourse during an erection and during urination.
Problems with urine emission are an unpleasant sign in the last stages of phimosis, when the skin of the foreskin grows together and forms a cavity with a very small hole. Urine may go away drip or thin stream.
If the infection is brought in and the inflammatory process begins - pus may be released, the temperature may rise, pain is inevitable.
Severe cutting pain in the head of the reproductive organ of men indicates a possible pinching and the need for emergency assistance.
Reasons for the appearance
The etiology of the appearance of phimosis is studied by scientists to this day, but the main reasons are:
Heredity - the body does not produce a sufficient amount of an elastic component, and by the time of puberty, physiological or congenital phimosis does not pass on its own, the development of the disease continues.
Infectious and inflammatory processes in the cavity of the foreskin - lead to the appearance of scars consisting of less elastic tissue. The fusion of the foreskin with the head is possible.
Injuries leading to scarring in the foreskin. Microtraumas occur when trying to independently get rid of phimosis, stretching the foreskin with excessive force. The first sexual intercourse, attempts to masturbate at a young age, can often be accompanied by injuries during an erection.
Hormonal rearrangement and rapid growth in adolescence can lead to a mismatch between the grown penis and the remaining small foreskin.
Regardless of the causes of phimosis, specialist advice is required, self-medication is unacceptable.
It is necessary to approach the diseases of the reproductive organ responsibly if today the foreskin has difficulty, but opens the head of the penis, tomorrow paraphimosis can occur - one of the main complications of the disease under consideration. At the same time, a man is shocked, and not in vain. The head of the penis is infringed, there is a sharp swelling, it is impossible to adjust it independently. The organ turns blue in the eyes, pain builds up, and if urgent measures are not taken - reduction of the head of the penis or immediate surgical dissection, tissue necrosis is possible.
Another unpleasant complication of phimosis, if left untreated, is balanoposthitis. This happens due to the inability to carry out thoroughly hygienic care of the glans penis, sperm and microorganisms remain in the prepubic bag, and if an infection gets in, the inflammatory process develops.
It can be acute, with high fever and purulent discharge, in this case, a urologist is definitely visited and treatment is carried out. If the form is chronic, folk methods help for some period, but an adhesion process, the fusion of the head with the foreskin can develop.
The same often happens on the third and fourth degrees of phimosis, when the foreskin is almost motionless. Synechiae appear, areas of adhesion between the inner leaf and the head itself, they expand. This process in normal condition does not deliver any unpleasant sensations. But when trying to expose the head appears sharp pain and bleeding. The separation operation is quite complicated, it is better to visit a doctor in a timely manner and get rid of phimosis.
Treatment of phimosis: a review of existing methods
You can permanently get rid of phimosis using surgery.
Circumcision (circumcision) is performed at any degree, while the foreskin can be removed completely or partially. If the disease is started, at the third or fourth stage, there is inflammation or blood circulation is disturbed, a longitudinal dissection is performed, followed by cosmetic surgery. The use of hormonal drugs phimosis does not completely cure. With their help, you can relieve inflammation, swelling, slightly increase the elasticity of the skin of the foreskin and stop the development of phimosis.
In the initial stages of phimosis, special exercises are practiced at home. They must be done very carefully so as not to get tears or infringement.
The best treatment is prescribed by a practicing urologist; self-medication of a genital organ is unacceptable.
How to treat phimosis?
If this does not happen, a specialist can advise you on two methods of treatment: surgical (surgical) and conservative (non-surgical).
For some reason, information about surgery is most often found on the Internet, and it is extremely small and difficult to find any useful tips on alternative methods of treating phimosis. Many progressive doctors claim that today in many cases it is possible to avoid surgery by treating phimosis at home (before this, you must contact a medical institution!)
The doctor can "give the green light" to do it yourself with hypertrophic phimosis (in this case, the patient has an excess of the foreskin, which interferes with the excretion of the head). And then only if there were no complications - impaired urination, inflammation of the foreskin, and so on.
Conservative ways to remove phimosis at home is to gradually stretch the foreskin with the help of special tools.
Tips for Parents
Parents perform these manipulations at home. Usually this happens: 3-4 times a week while swimming in very warm water (it is best to bathe in decoctions of herbs - chamomile and a string), you need to shift the foreskin to a painful moment. After that, a few drops of sterile paraffin oil must be introduced into the prepuce space.
This home treatment for phimosis lasts several months. All manipulations must be performed very carefully to prevent paraphimosis. Success depends on the persistence of parents and the severity of phimosis. If there are scars on the penis, such conservative therapy is unlikely to help, and then surgery will be recommended.
In recent times, independent correction of phimosis is done with the help of hormonal ointments, which must be laid in the prepuce space. They facilitate tissue stretching. Treatment is carried out by parents with the obligatory supervision of a doctor.
Modern methods of getting rid of phimosis are recommended to start all the same with non-surgical intervention, and only if unsuccessful resort to surgery.
Health to you and your children!
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General recommendations for the treatment of phimosis at home
Based on the age characteristics of the patient, different methods of treatment are possible. Physiological phimosis in boys in the first year of life does not require medical intervention. Doctors advise parents of babies to pay special attention to hygiene procedures. Usually, by the age of 3, phimosis disappears in children, but if this does not happen, you need to consult a specialist.
In children over 11 years of age, the likelihood that phimosis will go away by itself is only 2%.
After 13 years of age, treatment is already beginning immediately. It is necessary even when the boys have no unpleasant symptoms. At first, they try to cure phimosis with the help of conservative therapy, without surgery. Surgical manipulations are resorted to when natural urination is difficult. When cicatricial changes appear on the penis, circumcision becomes the only way to solve the problem.
Conservative therapy is prescribed both with the use of drugs and without them. In the first case, doctors prescribe glucocorticosteroid external agents (ointments). They increase tissue elasticity. Ointments are easy to use: it is enough to apply the product a thin layer on the problem area twice a day. But treating phimosis with glucocorticosteroids for longer than 3 months is impossible!
Hormonal ointments are good because they inhibit the formation of connective tissue, increase the extensibility of the skin. In addition, external products have other useful properties:
- eliminate itching
- reduce pain
- relieve inflammation
- eliminate irritation
- microcracks heal.
Non-pharmacological methods include daily massage after a shower or bath, as well as stretching the skin of prepuce. The combination of these two methods gives good results, allows you to do without circumcision of the foreskin.
Conservative therapy gives excellent results in children and adolescents, so it is often used in young patients. But before treating the disease in boys with glucocorticosteroids, it is imperative to undergo an examination and strictly follow the doctor's recommendations. The child's body is sensitive to hormonal drugs, side effects often occur from them.
How to cure folk remedies phimosis
Traditional medicine in the treatment of phimosis are effective. They allow you to free the head of the penis, avoid complications and permanently get rid of the disease without surgery. Home treatment of phimosis is aimed at restoring the elasticity of prepuce. This is achieved with the help of baths and massage techniques. At home, decoctions and infusions of chamomile, sweet clover, string, barley, strawberry leaves are prepared.
Chamomile infusion pharmacy
Make an infusion is easy. To do this, 10 g of dried chamomile color is poured into 250 ml of boiling water. Withstand the tool for about a quarter of an hour. After filtration, the infusion is ready for washing and bathing. Chamomile relieves itching and pain, as well as softens the skin and helps to stretch the skin of the prepuce during a subsequent massage.
Infusion of calendula and succession
To make a therapeutic decoction of calendula or a string, take 10 g of plant material and boil it in a glass of boiling water. The calendula infusion is kept for about an hour, and the sequence is left for several hours. The filtered product is used for washing and steaming baths.
To make a therapeutic product at home, you will need to soak 50 g of barley in 500 ml of water in the evening. In the morning, the infusion is boiled for no more than 10 minutes, after which they still stand for about an hour. The resulting product is filtered and used to wash the prepuce.
Melilot from phimosis
To get a decoction of clover from phimosis, you need to pour 1 tablespoon of dry raw materials into 250 ml of boiling water and simmer for 5 minutes over low heat. The tool must be allowed to cool, filter it and only then apply to lotions. .
Baths with any herbal infusions and decoctions should be done systematically, 2-3 times a day.
What is not recommended
As already mentioned, therapy with physiological narrowing of the foreskin comes down to steaming baths, washing of the prepuce and further massage of the problem area.
Parents are forbidden to push the foreskin with force during any water procedures.
Do not expand the hole of the prepuce on your own, since there is a high risk of injury to it with the further development of necrosis or scars.
Probable causes of phimosis in boys
It is necessary to clearly distinguish between physiological and pathological phimosis. In boys, from the very birth, the prepuce is narrow and does not allow the head of the penis to be exposed. This physiological feature helps protect delicate skin from mechanical injuries and protects against the penetration of infections. A similar anatomy is observed in children under 7 years of age and is not considered a deviation.
It is this condition that is called physiological phimosis. To get rid of it, usually no measures are needed. But some parents (more often for religious reasons) prefer to circumcise a prepuce to their son in order to avoid further problems.
Without circumcision, physiological phimosis disappears in 50% of boys before the age of one year, and in three-year-old babies it disappears in 90% of cases.
Only in 10% of seven-year periods physiological phimosis persists. The exact reasons for it are unknown, but experts suggest that a genetic predisposition comes to the fore.
If the full opening of the head of the penis is still impossible, although the age of the norm has already passed, we are talking about pathological phimosis. This type of pathology is promoted by
- mechanical damage,
- insufficient elasticity of the epithelium,
- balanoposthitis is a complication that provokes cicatricial changes in the epithelium.
Against the background of pathological phimosis, the process of emptying the bladder is disturbed. Urine flows in a thin stream, stagnates in the urethra, which provokes bloating of prepuce. In such circumstances, surgical treatment is inevitable, but the operation is performed only in a hospital - this is the case when circumcision at home is unacceptable.
The main symptom of phimosis is difficulty or the complete impossibility to free the head of the penis from prepuce. But against the background of this problem, other symptoms arise:
- sore urination
- enlarged inguinal lymph nodes,
- purulent discharge when pressing on the head of the penis,
- when the bladder is empty, a weak stream of urine (or urine is excreted in drops).
Parents do not always find the problem on time, because even with prolonged narrowing, prepuce symptoms may be absent. You should be especially vigilant and pay attention to other signs of phimosis. For example, when under the pressure of a stream, urine accumulates briefly under a prepuce in the form of a ball.
With phimosis, an acute delay in urine is likely. This reflex state is characteristic of very young children. The delay is due to pain caused by pinching of soft tissues. Against this background, the baby does not go to the toilet for a long time, he is restless and complains of pain in the abdomen or in the area above the pubis. In such cases, parents urgently need to seek medical help.Early diagnosis of phimosis and compliance with the recommendations of a pediatric urologist or surgeon will quickly and permanently forget about the problem.
When allowed to be treated at home
If there is a suspicion of phimosis (in boys or men), before starting treatment at home, you should make sure that this is permissible. Treatment of phimosis without surgery in adults and children is possible in the following situations:
- a doctor’s examination was conducted, the results of which indicate the presence of a mild stage of the disease,
- the doctor believes that the method for stretching the foreskin may be effective during treatment, and will provide the necessary information about its implementation,
- procedures for stretching the foreskin do not cause pain,
- the patient complies with hygiene rules,
- treatment is carried out on a regular basis,
- sexual relations are completely excluded,
- hands are treated with an antiseptic before procedures,
- creams are used to avoid the formation of injuries due to friction.
With such a diagnosis as phimosis in men, treatment at home is possible only if all of the above conditions are met. If this is not the case, any actions aimed at overcoming this problem can cause complications.
The method of stretching the foreskin
In order to figure out how to cure phimosis, it is necessary to take into account such a method of medical intervention as stretching the foreskin. It is best suited for patients of mature age, as they are able to master the principle of action and track changes in their well-being. Teenagers around the age of 13 cannot accurately assess their condition and carry out this procedure correctly. And in relation to boys under the age of one year, specialist control over the conduct of such actions is necessary. But even in relation to adult patients, preliminary consultation and instruction is required, since improper exposure will not only not help the patient, but also cause him injury. Otherwise, this method demonstrates high efficiency, especially if the disease is in a mild or moderate stage of development. Therefore, it makes sense to familiarize yourself with the technique in more detail.
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The fastest results are characterized by the procedure using the Glansha. This is the name of a special tool designed to stretch the foreskin. But despite the possibility of achieving results faster, this method is considered dangerous, since glanders during careless handling can cause injury. Therefore, most often for home treatment, a manual version of the procedure is used.
Hands should be pre-treated. For this, it is best to use antiseptic agents that do not contain alcohol. In addition, it is important that the skin in the area of the forthcoming exposure is softened. To achieve this, it is best to take a bath with potassium permanganate or essential oil. In such a bath you need to be about half an hour. After this, you need to apply a baby cream (necessarily hypoallergenic) to the foreskin. This will provide additional softening and protect the skin from injuries due to possible friction. The cream should be applied in a thin layer, making massaging movements. Only after the cream is completely absorbed, you can start stretching.
The first way to carry out the procedure is to slowly raise the foreskin up. This should be done until pain occurs. As soon as they appear, the action must be stopped. In no case should you continue the procedure if the patient is in pain. It may be dangerous.
In order to use another way of conducting this treatment procedure, you need to find out everything about it from your doctor. The principle of exposure is to introduce two fingers into the foreskin and carefully spread them apart. The occurrence of pain in this case is a signal to stop exposure. Its presence indicates that the foreskin is too tight, and if you continue the procedure, you will be injured. After the actions are completed, you need to re-treat the skin with cream and antiseptic.
A very important aspect of such treatment is its continuity. You must perform the described actions daily, only then you can achieve results.
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Features of drug treatment
In the treatment of phimosis, synthetic drugs based on corticosteroids are often used. This method of exposure does not require placement of the patient in a hospital. But we must remember that the drugs of this group are not suitable for every patient, therefore it is unacceptable to use them without a doctor’s prescription. They have contraindications as well as side effects. It is especially dangerous to use such drugs in the presence of infectious diseases of the genitourinary system.
Among the drugs used to treat phimosis, it is worth mentioning:
It is very effective to use corticosteroid ointments in combination with the technique of stretching the foreskin. Treatment in this case involves the treatment of tissues of the glans penis and foreskin. Thanks to this effect, it is possible to:
- weaken inflammatory processes,
- increase skin elasticity,
- neutralize irritation
- eliminate itching
- accelerate the healing of microcracks in the damaged area,
- reduce pain.
Also, these ointments help to increase the effectiveness of other applied methods of therapeutic effect.
Traditional therapy shows high results in relation to children and adolescents, therefore, most often it is used for them. Nevertheless, the child’s body is much more sensitive to the likely side effects of such drugs, therefore, with phimosis in young boys, it is necessary to undergo an examination and follow the recommendations of a specialist.
The use of folk remedies
In addition to traditional medicines, phimosis is often treated with folk remedies. Do not rely on doctors to rely on them, however, it is worth using the properties of medicinal plants to more quickly achieve the goal. True, you need to consider the contraindications available to traditional medicine. Usually they are associated with the individual sensitivity of the patient. But if there is no allergy, you can use the following medicines:
It is an effective bactericidal agent, therefore, with phimosis, baths based on it and compresses are very useful. To prepare a medicinal composition, dried flowers of this plant (1 teaspoon) will be required. Raw materials should be poured with a glass of boiling water and insisted for about an hour. After the resulting infusion has cooled, it is necessary to lower the genitals into it. The exposure time of such a bath is from 10 to 20 minutes.
This plant helps soften the skin and reduce inflammation. Thanks to her, itching also weakens and pain disappears. That is why the use of lotions and baths with Chamomile is common. Chamomile flowers need to be dried (or buy a dry Chamomile in a pharmacy), take 10 g of the product and pour a glass of boiling water. Before the medicine is ready, it should either be boiled over low heat for 15 minutes, or insisted for at least 5 hours. Before use, the infusion must be cooled and filtered.
It has an anti-inflammatory effect, eliminates pain and itching, and also heals microcracks. To prepare the infusion, you need 10 g of the plant and a glass of boiling water. The time it takes to brew is 2-3 hours. After cooking, strain the broth and make baths lasting 15 minutes.As an auxiliary effect, the use of barley decoction or infusion of blackberry leaves is also acceptable. You can not use these funds without a doctor's prescription or if adverse events are detected. Phimosis is too risky a disease to be careless in its treatment.
Children's phimosis: what is it
Phimosis is a state of fusion of the foreskin with the head of the penis by adhesions, otherwise - by synechiae, which interfere with the free exit of the head. Physiological phimosis in infants is a normal condition, only in a very small number of infants the head immediately opens freely. It is believed that such a fusion at a young age is necessary to protect the body from harmful bacteria.
Up to three years, no conservative treatment or operations are carried out, during which time the problem should be solved by itself. Further medical intervention may be needed, but not in all cases. If the fusion of the foreskin does not cause discomfort, does not interfere with urination, you can postpone the therapy.
Pathological phimosis is a condition where the fusion of the foreskin causes painful sensations and interferes with normal life. Pathological phimoses are divided into two groups:
- Cicatricial phimosis. This form is also called atrophic. With it, the foreskin loses elasticity due to scarring.
- Hypertrophic phimosis. This form is characterized by an excess of tissues of the foreskin, which prevents the exit of the head.
The treatment for both forms of the disease is similar. The main indicators of the need for intervention are some symptoms.
There are a number of reasons why this disease develops.
- Congenital phimosis occurs with some disorders in the formation of organs. This is the most common case of the disease.
- Genital injuries, the consequences of poor healing after surgery. In this case, scars form on the connective tissue, which reduce the elasticity of the foreskin and cause its narrowing.
- Balanoposthitis. This inflammatory disease can be the cause and consequence of phimosis. With extensive damage, there is a likelihood of narrowing of the foreskin.
In most cases, it is impossible to influence the occurrence of this condition in very young children, since it is normal at a certain stage. It is important to maintain hygiene so that no complications arise.
Balanoposthitis is an inflammatory process in the foreskin and glans penis. It arises due to the accumulation of smegma - a specific secret, residues of urine and other secretions, and the multiplication of bacteria in them. Normally, with careful hygiene, this problem does not occur, but with phimosis it is impossible to carry out a full toilet, which leads to inflammation.
For balanoposthitis, the following symptoms are characteristic:
- itching, pain,
- redness of the head and tissues around,
- purulent discharge.
Look at what balanoposthitis can lead to (photo) in boys.
Balanoposthitis is an occasion to immediately consult a doctor.
Acute urinary retention
More often occurs in very young children as a reaction to pain during phimosis. The child can not commit an urination act, palpation of the lower abdomen feels a strained full bladder.
Acute urinary retention is a dangerous condition that requires urgent care. Usually they try to achieve urine waste using local means, in some cases, the introduction of a catheter is required.
Paraphimosis is the result of too rude, unsuccessful attempts to remove the glans penis from the foreskin. It arises from the constriction of the penis with the foreskin ring, which causes pain.
Important! In no case should you try to independently push the soldered skin with phimosis.
Blood vessels are squeezed, tissues suffer from a lack of oxygen. Therefore, without timely therapy for paraphimosis, gangrene or necrosis of the penis may begin. This can lead to organ removal.
The main signs of paraphimosis:
- swelling of the glans penis,
- strong pain.
A complete fusion of the tissues of the foreskin is also likely, which will make access to the head impossible. In this case, surgical intervention is necessary.
Home treatment without surgery
In the treatment of phimosis at home, various methods are used, sometimes they are combined.
- Mechanical stretching of the foreskin with a light pull on the glans penis. It is also used in young children with mild disease severity. This should be done carefully, taking care not to damage the organ and not cause pain. When light discomfort appears, the exercises stop. It is better to do this after bathing, in warm water the tissues become more elastic.
- Hydrocortisone Ointment. This tool is used much less often, mainly in adults, since hormonal ointments have a rather aggressive effect and a lot of contraindications. It is not recommended to use it without a doctor’s prescription.
- Vaseline with phimosis can be used to soften the foreskin and carry out the pulling procedure.
- A solution of furatsilina or potassium permanganate. Usually used when inflammation occurs. A careful washing of the foreskin is done, then stretching exercises continue.
Important! Before treatment, you should consult your doctor.
Surgery is required in case of complications or inefficiency of conservative drugs.
Usually do circumcision - circumcision of the foreskin. Sometimes this operation is done to prevent the development of phimosis and other inflammatory diseases of the penis. During the operation, the excess foreskin is removed, the head is freed. It is important to remember that after the intervention it is necessary to conduct hygiene procedures even more thoroughly until complete healing.
Folk remedies will help speed up the treatment process and can act as a local anesthetic, because children should not take most drugs.
- Chamomile. This plant has anti-inflammatory and soothing effects. Based on the infusion of chamomile, you can make baths and lotions. A spoonful of dried grass should be poured with a glass of boiling water and insisted for five hours. After you need to strain.
- Calendula. It has an antibacterial and anti-inflammatory effect. You need to take a teaspoon of dried flowers of the plant, pour a glass of hot water, leave for about an hour. Then, make baths with the resulting solution.
The main thing is to ensure that the baths are not too hot, it is better to completely cool the decoctions. The procedure should not last more than 15-20 minutes. After it, you should do exercises to stretch the foreskin.
Important! An allergy to medicinal plants may occur, in this case, folk remedies should be discarded.
It is impossible to defend oneself from the physiological form of the disease; this is a normal condition for most young children. It is necessary to prevent the development of the pathological form and the appearance of inflammation, then the likelihood that the problem with age will resolve by itself is extremely high.
The genitals of a young child should always be kept clean. After changing the diaper, washing is mandatory.It should be done from front to back, otherwise the likelihood of infection increases.
Do not try to move the foreskin, if it does not lend itself at all. This can cause pain and anxiety in the baby, in the worst case, paraphimosis appears.
Subsequently, you need to teach your child to keep his body clean. It is worth remembering that the likelihood of developing pathological phimosis persists at any age, but the older the person, the more it depends on his cleanliness and accuracy.
If you follow these simple rules, physiological phimosis will never go into a pathological form.
BASIC COMPLAINTS WITH PHIMOSIS?
Complaints with phimosis are itching and burning in the head area, if the foreskin and the head of the penis become inflamed, difficulties may arise during sexual intercourse. Due to prolonged inflammation, the foreskin becomes denser and loses its elasticity and sensitivity, and scar tissue appears. The head is completely or partially not exposed, because of this the hygiene of this area is difficult, inflammation occurs, infections join.
DIFFERENT FOUR DEGREES OF PHIMOSIS DEVELOPMENT:
The first degree includes the condition when the head of the penis can be opened only outside the erection, difficulties and discomfort arise during erection. The second degree when the head is not exposed outside the erection and during the erection. Either the head of the penis is exposed outside the erection, but not completely and with great difficulty. The third degree of withdrawal of the head does not work at all, or it can be done only outside the erection and with great difficulty. The fourth degree the head of the penis is not exposed, the lumen of the foreskin is very narrow , which causes difficulty in urinating, urine flows in drops or a thin stream.
WHAT IS A PHYSIOLOGICAL PHYMOSIS?
Physiological phimosis is one of the age characteristics of young boys, when difficulties also arise with exposing the glans penis. Congenital narrowing of the foreskin is also often combined with a short frenum of the penis. When physiological phimosis of the head occurs, difficulties arise in caring for it. Due to hygiene problems, the constantly produced lubricant on the inner surface of the foreskin can become infected and cause inflammation (balanoposthitis in boys). Due to such prolonged inflammation, adhesions can occur between the head and foreskin.
PHYSIOLOGICAL PHIMOSIS TREATMENT?
Some urologists, when balanoposthitis occurs in a young child with physiological phimosis, forcefully open the head to handle it, which causes wild stress and pain in the child. Moms need to know that this disease can be combated without causing even more discomfort to an already sick child. A urologist prescribes anti-inflammatory baths, washing with antiseptics between the head and foreskin and ointment locally (without forcibly opening the head), of course, all these measures must be performed under the supervision of a doctor. In most children, physiological phimosis gradually decreases over the years, and most often by the time of puberty decreases, and surgery is not required. But if the head of the penis did not open by puberty, then surgical treatment is inevitable. With physiological phimosis in boys, it is also recommended to systematically try to stretch the foreskin during bath procedures, i.e. try to expose the glans penis, but do it gradually without causing pain to the child. The effectiveness of these measures can be assessed no earlier than in a month.
The cost of treatment:
The cost of the initial consultation of the urologist-andrologist, Ph.D. - 2000r
The cost of a second consultation of a urologist andrologist, Ph.D. - 1700r
The cost of the circumcision surgery (circumcision) is from 18,000 to 25,000 rubles, the cost depends on the severity of the formed scar, which complicates the course of the operation.
What you need to know before starting treatment?
In most cases, treatment of phimosis can be carried out without resorting to complex medical procedures and even surgical treatment. Treatment tactics will depend primarily on the form of phimosis (see Fig. 1) and the severity, as well as on the presence of other concomitant pathology. In any case, treatment tactics are based on simple to complex. In most cases, they first resort to non-drug methods that are associated with the gradual extension of the foreskin. In the absence of effect, they switch to conservative therapy with the use of specialized drugs.
Fig. 1 - Forms of phimosis.
If symptoms of phimosis are detected, consult a urologist to determine the form of the disease and select a treatment.
Non-drug treatment of phimosis
Elimination of narrowing of the foreskin without surgical treatment is used only in the first stage of phimosis, when the narrowing is insignificant and head exposure is possible if the penis is not in an erection state. For this, various methods of stretching the foreskin tissue are used. Stretching can be done:
- in a manual way
- using specialized expanders.
Manual stretching of the foreskin is carried out in two main ways:
- Stretching the foreskin by gradually pulling the latter on the glans penis. The procedure is best done while swimming, as in the water the foreskin becomes more elastic. Never stretch the foreskin until pain occurs, this can lead to a worsening of the condition. Also, stretching the foreskin with the help of the head can be done during urination, but again, do not bring the stretching to pain.
- The second method consists of introducing two fingers into the skin fold or prepuce sac of the foreskin, followed by their slow dilution. This allows you to stretch the foreskin at a time when the penis is not excited.
In addition to manual stretching, there are special medical devices that allow this procedure. One such is the Glansha instrument. It has certain limitations - it can be used if only the foreskin ring is narrowed by no more than 6 cm.
Fig. 2 - Glansha tool for stretching the foreskin.
For the procedure, the final part of the Glansha instrument with the extension is introduced into the foreskin ring, then the handles of the instrument slowly close, and the working end diverges and expands the ring. On the handle of the tool there are special notches (cremallera) that allow you to conveniently control and record the tensile force.
The procedure for stretching the foreskin is carried out systematically, it is very important for the development of a good effect. For greater effectiveness, in some cases, a combined conservative treatment is possible. The method is effective only in the very initial stages, and to develop a good and lasting effect you will have to find patience. Treatment of phimosis without medications using manual stretching or the Glansha apparatus takes from several weeks to 3 months.
During the procedures, it is important to ensure consistent and quality hygiene of the male genital organs.
For more advanced forms of phimosis, in stages II and III, the mandatory component of conservative treatment is the use of corticosteroid anti-inflammatory drugs. Apply them locally in the form of ointments in long courses.
In modern urological practice, drugs such as:
- Betamethasone. Synthetic corticosteroid drug. It has a higher activity in comparison with its natural counterparts. It also has an anti-inflammatory, local anesthetic effect,
- Clobetasol. It has an exclusively local effect, so the risk of side effects from this drug is extremely small. It is great for long-term systemic therapy of penile phimosis.
- Budesonide. An analogue of prednisolone has similar effects. But not recommended for long-term use.
The effect of glucocorticosteroids is to increase the elasticity of the foreskin and faster healing of microcracks and its defects. In the case of inflammation, topical use of glucocorticosteroids helps eliminate puffiness, which also reduces the degree of phimosis.
In general, drug therapy is used in several courses and has a good effect on stages I and II of phimosis. Very often, drug treatment is combined with stretching the foreskin, which can increase the effectiveness of the treatment. In stage III, glucocorticosteroids are also used, however, with inefficiency, the usefulness of their use disappears. Then they proceed to radical treatment - surgical intervention.