What do parents of boys need to know about Phimosis
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Phimosis is a condition in which the glans penis does not come out due to an obstruction created by the foreskin.
Boys are born with physiological phimosis: the foreskin is always fused to the glans penis. Until the age of 5, it is not necessary to open the glans penis. The fact that it is closed is the norm. If the head is forcibly opened, the foreskin and adhesions will rupture, scar tissue will form, which will aggravate phimosis.
If there are no problems with urination and phimosis does not affect the shape of the penis, it can be observed until puberty. Then, under the influence of hormones, the penis will begin to grow and phimosis will resolve itself.
“In some boys, the head begins to open quite early,” says GMS Clinic pediatrician Emilia Gavrilova . – For most, it is closed until 7-10 years old, and this is normal. If the head has not opened by this age, the pediatrician examines the child and, guided by the type of foreskin and the presence of related problems, either allows you to wait more or sends the child to a urologist.
Physiological phimosis is important to control. Improper care can lead to inflammation of the foreskin, which is called balanoposthitis. If the foreskin is constantly damaged (for example, when trying to open the glans penis), it begins to thicken, which leads to cicatricial phimosis.
Most pediatric urologists adhere to observation tactics up to 7 years. If the head does not open, it is recommended to carry out simple exercises at home. After a good steaming of the body in the bathroom, you need to roll up and stretch the foreskin. It is important to do this gradually without pain for the child. If there is no result in 3-5 months, an operation is recommended.
For young children, the best option is Plastibel surgery. It is performed under anesthesia. A special medical tip is inserted into the foreskin, around which a thread is tied. Excess foreskin is cut off. After 3-5 days, the cap falls off and phimosis no longer bothers.
The second method is the classic circumcision with the removal of all the foreskin. It differs from the previous technique in that the head remains completely open.
Phimosis can turn into paraphimosis. This is an acute condition in which the head is brought out through the narrowed foreskin, but it is no longer set back. She quickly swells and starts to hurt a lot. In this case, you need to urgently contact a surgeon to reduce paraphimosis until the tissues of the head have become dead.
One of the additional methods of treating phimosis is the appointment of hormonal ointments. This method is effective for softening scar tissue. In other cases, treating phimosis in this way is ineffective.
“It is difficult to say at what age it is better to operate on phimosis,” says Alexander Dzidzaria, head of the department of oncourology and oncogynecology of the Federal State Budgetary Institution RRCRR, candidate of medical sciences, urologist, oncologist, andrologist. – Sometimes surgery is not needed – phimosis disappears on its own or with the help of conservative treatment with hormonal ointments. It is definitely necessary to operate on phimosis in cases where it interferes with urination and inflammatory processes of the foreskin often occur.
Balanoposthitis, smegmal stones, erection
Inflammation of the foreskin is called balanoposthitis. The condition is manifested by its redness, discharge of pus, the inability to remove the head, pain, and even an increase in body temperature.
This is usually caused by phimosis, infection in the smegmal sacs – pockets between the head and the foreskin. This condition passes in 1-3 days. To make the pus come out faster, baths with chamomile are prescribed. Frequent balanoposthitis is an indication for circumcision, otherwise constant inflammation can lead to the development of scar tissue. Balanoposthitis in boys without phimosis may occur against the background of the development of diabetes mellitus.
Smegmal stones are an accumulation of physiological lubricant between the glans and the foreskin. They are white, painless, do not disturb the child. But if an infection gets to them, balanoposthitis can develop.
An erection in children under one year old often occurs before urination and is the norm. After 5 years and before puberty, morning erection is also the norm, it disappears after urination.
“Inflammation of the foreskin does not always have to be treated by a urologist. The competence of the pediatrician includes the treatment of most cases of inflammation of the foreskin, provided that there are no associated problems, ”explains Emilia Gavrilova.
The testicles are laid and develop in the abdominal cavity of the embryo. Before the birth of a child, under the influence of the hormone chorionic gonadotropin, they descend into the scrotum. In the place where the testicles come out of the abdominal cavity, part of the inner shell is captured: a thin sheet of connective tissue.
Normally, after the testicles descend, this sheet should stick together from the inside and turn into connective tissue. If it does not grow together at all, a hernia appears. If it does not fuse in the right place near the testicle, dropsy occurs. The inner wall of this sheet is capable of producing a liquid that does not have time to be absorbed into the tissues.
Dropsy without strong pressure on the testicles is not dangerous and requires observation. Until the end of the first year of life, dropsy can go away on its own without surgery. It is pointless to pierce dropsy to pump fluid out of it: in a few days it will again accumulate in the cavity.
For diagnosis, palpation of the testicles is sufficient: there is a feeling that the testicle is floating in the liquid. The diagnosis can be confirmed with an ultrasound.
Dropsy in children is operated on through the inguinal canal. The main task of this operation is the removal of the process of the peritoneum and its ligation. Then the membranes of dropsy near the testicle are dissected. There are usually no recurrences after such an operation.
In children over 14 years of age, the option of surgery through the scrotum is considered, by removing the membranes of dropsy, without removing the process of the peritoneum.
Sudden dropsy is a possible consequence of inflammatory processes in the scrotum. Usually it is not associated with the abdominal cavity and requires immediate treatment, rather than elective surgery.