Phimosis in a child: when to go to the surgeon?

is a disease that manifests itself in the form of narrowing of the foreskin. As a result, the head of the penis cannot be opened or opens with difficulty and pain.

The degree of development of phimosis may vary:

• 1st degree – difficulty opening the head only during an erection; in a calm state there are no problems;
• 2nd – during an erection, opening of the head is impossible, in a calm state the problems are insignificant;
• 3rd – opening of the head is impossible even in a calm state;
• 4th degree - there are problems with urination - the opening in the foreskin is so narrow that urine cannot flow out freely.

Causes of phimosis

There are physiological and pathological phimosis.

Phimosis in children

considered physiological: in most newborns, the foreskin does not allow the head of the penis to be exposed. Up to 90% of children have a narrowing of the foreskin at birth. By the age of 6-7 years, phimosis is observed in only about 10% of children. However, until 6-7 years of age, insufficient mobility of the foreskin is not yet considered a pathology. Difficulty opening the head at an older age is already pathological (or true) phimosis.

Phimosis in adults

may persist from childhood, or may develop later - during puberty. The main reason for the development of phimosis in this case is the discrepancy between the growth rates of the glans penis and the foreskin. Against this background, the onset of erections lead to microscopic tears in the mucous membrane, resulting in the formation of scar tissue, which contributes to even greater narrowing. As a result, the disease progresses.

Various injuries to the penis and inflammation of the foreskin (balanoposthitis) also lead to the formation of scar tissue, which contributes to the development of phimosis.

Other forms of the disease

Forms of hypospadias:

• Features of the capitate shape

This form is characterized by the fact that the external opening of the urethra is located slightly proximal to the apex of the glans penis to the groove. The foreskin is usually dysplastic. With capitate hypospadias, the penis has a slight ventral curvature. Complaints include narrowing of the external opening in the genital canal, a thin stream of urine, and changes in the appearance of the penis.

• Crown shape

With coronal hypospadias, the external opening of the urethra is located in the area of ​​the coronary sulcus. The foreskin is located on the dorsal surface in the form of a “hood”. A ventral curvature is noted. Complaints about a narrowed meatal opening. When urinating, the stream is directed at an angle to the urethra. The capitate and coronal forms are anterior anomalies. In the trunk form, the external opening of the urethra is located at different levels of the trunk. The penis has a more pronounced curvature, the stream is directed downwards. In order to urinate while standing, you have to pull your penis towards your stomach.

• Stem form

The stem is usually classified as a middle type of pathology.

• Scrotal

Scrotal hypospadias or penis-scrotal hypospadias refers to the posterior forms of damage to the genital organ. With such hypospadias, the external opening of the urethra is located in the area of ​​the scrotum or at the border of the scrotum and the shaft of the penis. There is a pronounced ventral curvature of the corpora cavernosa or transposition of the penis. Urination is possible only in the female type while sitting. The external genitalia resemble the labia majora and an enlarged clitoris. In most cases, consultation with an endocrinologist is necessary.

• Perineal

Perineal hypospadias - with this anomaly, the external opening of the urethra opens at the perineum, the corpora cavernosa are significantly curved, the scrotum is split, and urination is female-type. The external genitalia have a mixed structure. Quite often a consultation with an endocrinologist or geneticist is required.

• Hypospadias without hypospadias or hypospadias of the chord type.

Chord type hypospadias or hypospadias without hypospadias is a special type of disease. With this pathology, the external opening of the urethra is located at the top of the head, but there is a curvature of the penis of varying degrees of severity. Curvature in such a disease can only be due to skin dysplasia on the ventral surface, a combination of skin dysplasia and the presence of connective tissue cords along the urethra, underdevelopment of the urethra itself.

Treatment is described in more detail on the page surgical treatment of hypospadias.

The optimal age for treatment is from 6 to 18 months of the child’s life. At this age, children tolerate the operation itself and the postoperative period much easier. Children operated on before the age of 3 usually do not even remember the fact of the operation.

Complications of phimosis

Phimosis in children is often accompanied by fusion of the foreskin with the skin of the glans penis (penile synechia).

Difficulties with hygiene procedures can contribute to the development of balanoposthitis.

Another possible complication is paraphimosis - pinching of the head of the penis by the foreskin. Paraphimosis is an emergency condition that requires emergency manipulation - repositioning of the glans penis (sometimes called repositioning of paraphimosis), which can be performed by a urologist on an outpatient basis. If it is impossible to perform this manipulation, urgent surgical treatment is indicated.

Symptoms of phimosis and paraphimosis

The main symptom of phimosis is difficulty in exposing the head of the penis, which may result in problems with urination.

During sexual intercourse, symptoms such as tears in the foreskin, bleeding, a feeling of pain, straining during urination, pain during erection, a feeling of skin tension, decreased potency as a result of psychological stress and pain may occur.

A symptom of paraphimosis is the inability to return the foreskin to its original position, which can result in pain, swelling, and blue discoloration of the organ. Also, closure of the head can cause lymphatic or venous congestion and impaired arterial bleeding. Pinching the head of the genital organ contributes to an increase in swelling and enlargement of the head itself, resulting in pain even at the slightest touch. Urination is usually difficult. If the foreskin does not return to its original position for a long time, diseases such as ischemia, partial necrosis of the glans penis, or the development of gangrene develop.

Phimosis treatment methods

Treatment of phimosis is surgical; the purpose of the operation is to rid the patient of phimosis, prevent balanoposthitis, penile cancer, urinary retention, genitourinary tract infections, and improve the quality of life.

In Moscow, regarding the treatment of phimosis, you can contact JSC “Family Doctor”.

Highly qualified urological surgeons at the Family Doctor will perform circumcision (surgery for phimosis). The operation is performed under local anesthesia.

Circumcision (cutting of the foreskin)

The only effective treatment for phimosis is surgery. As a rule, circumcision is performed - circumcision of the foreskin. In case of complications (balanoposthitis or paraphimosis), a longitudinal dissection of the foreskin is first performed. Longitudinal dissection solves the problem of opening the head, but in this case, after some time, it is recommended to carry out circumcision for cosmetic purposes.

More information about the treatment method

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Symptoms

The basic symptom of phimosis in boys or adult men is the partial or complete inability to expose the head of the penis.

In addition, the patient may experience:

1. Decreased potency.
2. Pain during urination.
3. If inflammation is activated, purulent discharge may be observed, the temperature may rise significantly and the lymph nodes on the body will significantly enlarge.
4. Disorders of urination - fluid flows slowly, in drops or in a thin stream, the preputial area is swollen due to the accumulation of urine there and the impossibility of its rapid removal.
5. With paraphimosis, a sharp pain develops in the head and penis, the pinched foreskin turns blue, the genital organ itself increases in size and becomes inflamed - this requires urgent surgery.

A doctor's help is necessary for the following symptoms of phimosis:

• increased body temperature;
• insufficient stream when urinating;
• swelling of the head of the penis;
• inflammation of the head of the penis;
• blue discoloration of the head of the penis;
• inability to fully open the head of the penis in children over seven years of age;
• enlarged lymph nodes located in the groin;
• the appearance of pus even with light pressure on the head of the penis;
• severe pain when urinating (small children cry for a long time after this process);
• drip urine output (in very severe forms).

The appearance of at least one of these symptoms indicates that phimosis has gone from safe, self-limiting with age, to pathological, requiring urgent treatment. In this case, leaving the child without treatment and waiting for the exacerbation of phimosis to go away on its own is not worth it. This can significantly worsen the child's condition and lead to much more complex treatment. For those mothers who do not want or do not have the opportunity to see a doctor to solve the problem, traditional medicine will come to the rescue, which is easy to use at home.

How to treat phimosis in boys?

Treatment of phimosis in children depends on its degree, as well as the age of the patient. Depending on the extent of the process, the recommended approaches are listed in the table below.

The following methods can be used:

1. Drug treatment. It is the use of hormonal ointments, such as Clobetasol, Bepantel, Betameson, Solcoseryl. They are needed to increase tissue elasticity, relieve inflammation, and heal microcracks.
2. Non-medicinal. This treatment for phimosis in boys at home consists of mechanical regular retraction of the foreskin. You should move the baby's foreskin by one millimeter twice a week. First you need to take a warm bath for 15 minutes with any antiseptic (decoction of chamomile, calendula or a weak solution of potassium permanganate). It is advisable to lubricate the problem area with baby cream. The maximum movement can be up to 2 mm; sudden jerks are unacceptable. These manipulations should be carried out only after instructions from a urologist.

Stages of development of methods for treating hypospadias.

Urologists around the world have been solving the problem of treating hypospadias for more than a century. As a result, about 200 treatment methods and many options for their use were proposed. Until the mid-90s of the 20th century, almost every large clinic used its own modifications of surgical interventions, and in the hands of the authors they gave good results.

A fundamentally new stage in the treatment of hypospadias began in the 90s with the spread of digital technologies. At international urological conferences, video materials of operations and long-term results are shown. Many articles are supplied with high-quality photographic materials. Finally, it became possible to compare different treatment approaches and choose the truly best method.

If in the old days, evidence of the effectiveness of treatment for hypospadias was often words - statistically unproven statements about the advantages of certain methods, now the time has come for randomized multicenter studies and technologies that have proven their advantages in hundreds and even thousands of patients from different countries.

Urologists around the world exchange technologies and results. Today, not a single doctor can say my method is the best. Dozens of surgeons from different countries contributed to the improvement of technical techniques. The skill of a surgeon consists in mastering the entire arsenal of treatment methods and the ability to apply them creatively, in accordance with the characteristics of the pathology and the interests of the patient.

Causes of hypospadias. Incidence of hypospadias.

The causes of hypospadias are hormonal changes in the body of the mother and fetus, as well as genetic defects. Hormonal changes can also be genetically programmed, but can also be a consequence of external and internal influences on the body of the mother and fetus. Genetically determined variants of the defect generally constitute a more severe group.

The question of possible causes of hypospadias requires a separate discussion. We are currently doing a lot of work together with endocrinologists, geneticists and gynecologists to more accurately answer questions about the reasons for the birth of children with hypospadias and the possibility of preventing similar defects in future offspring.

Hypospadias occurs in 1:100 to 1:1500 male newborns. Capitate and coronal hypospadias occur in approximately half of the cases. Truncal hypospadias in a third of cases. Severe forms of hypospadias occur in 10-20% of patients.

After artificial insemination, children with hypospadias are born 2-3 times more often. However, according to our data, there is no direct connection with the process of artificial insemination itself, and the characteristics of pregnancy, the threat of miscarriage, the degree of maturity of the child at birth and the phenomena of hormonal imbalance are of greater importance.