Treatment of phimosis in boys: drug therapy, surgical removal of the foreskin
Phimosis is a narrowing of the foreskin that prevents the head of the penis from being exposed. There are congenital (physiological) and acquired (pathological) phimosis. The causes of physiological phimosis are being born with a foreskin that tightly adheres to the head of the penis. As a rule, with age, the foreskin separates naturally. Phimosis is a normal condition for a child from birth to three years. According to recent studies, foreskin separation occurs between the ages of three and 18 years (average age – 10.4). Acquired phimosis is a consequence of the inflammatory process and scarring.
Treatment of phimosis in boys is necessary in case of difficulty urinating or spread of the infectious process. In the absence of complications (these can be urinary tract infections, balanitis, infravesical obstruction, skin diseases), treatment is not carried out.
Degrees of phimosis
There are four stages according to the degree of severity:
- I stage – the head of the penis is freely exposed only in a calm state, with difficulty - during an erection;
- II stage – the head of the penis is exposed with some effort in a calm state, and during an erection it is impossible to open it;
- III stage – the head of the penis opens in a calm state occasionally and for a short time;
- IV stage – the head of the penis is not exposed even at rest, painful urination is noted, the outflow of urine is difficult.
Each degree of phimosis is characterized by a certain clinical picture. In stages I–II, pain during erection is noted, in stages III–IV it is absent. The reason is the impossibility of exposing the head. Phimosis of the IV degree is characterized by a significant narrowing of the foreskin, which significantly impedes the outflow of urine. The external manifestation is the release of urine in drops. A characteristic sign of phimosis is swelling of the preputial sac. Increased pressure in it against the background of reduced pressure in the bladder at the end of urination leads to the reverse flow of urine through the urethra, which leads to its expansion and the development of the inflammatory process.
Phimosis in adult men
In adult patients, acute phimosis may occur as a result of thickening of the foreskin during balanitis. Conversely, phimosis can cause balanitis, because the accumulated smegma is inflamed. Complications of phimosis can also be balanoposthitis accompanied by inflammation of the foreskin and head of the penis, paraphimosis, urethritis, cystitis.
When examining a patient, the cause of the disease is first established. Phimosis in adult men can be caused by syphilis, herpes and fungal infection. If the sexual route of transmission of the pathogen is confirmed, the sexual partner must be treated.
Phimosis therapy begins with the appointment of corticosteroid ointments. Antibacterial therapy is carried out if necessary. If phimosis progresses, surgical treatment is recommended. The main operation for cicatricial phimosis is excision of the foreskin.
How to treat phimosis in children
Physiological phimosis usually does not require treatment. What to do with phimosis in a child over seven years old? It is enough to be observed by a doctor. Treatment of complicated pathological phimosis is carried out with the use of hormonal ointments. The drugs of choice are hydrocortisone 2.5%, betamethasone 0.05%, triamcinolone 0.01% and fluticasone propionate 0.05%. Ointments help to soften the dense foreskin around the head of the penis. The drug is rubbed in twice a day for 6-8 weeks, simultaneously stretching/retraction. As soon as the foreskin begins to easily expose the head of the penis, massage with hormonal ointment is canceled. To prevent recurrence of phimosis, perform daily manual retraction using warm baths.
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