Methods of treatment of phimosis in men( narrowing the foreskin)

Phimosis - narrowing of the foreskin of the glans penis, as a result of which the foreskin does not allow the head to be freely exposed. Phimosis is a fairly common disease that occurs in 2-3% of men. In some cases, phimosis is not a pathological, but a physiological condition. So, more than 90% of newborn boys have a narrowing of the foreskin, which passes by itself to 2-3 years. In the adult state, phimosis is a pathology and develops due to inflammatory processes localized in the area of ​​the external genitalia.

What you should know before starting treatment?

In most cases, treatment of phimosis can be done without resorting to complicated medical manipulations and even surgical treatment. Therapeutic strategy will depend primarily on the shape of phimosis( see. Fig. 1) and severity, as well as on the presence of other concomitant pathologies. In any case, therapeutic tactics are based on simple to complex. In most cases, first resort to non-pharmacological techniques, which are associated with the gradual extension of the foreskin. If there is no effect, they switch to conservative therapy with the use of specialized medications.

Fig.1 - Forms of phimosis.

Drug-free treatment of phimosis

Remedy the narrowing of the foreskin without surgical treatment is applied only at the first stage of phimosis, when the narrowing is small and exposure head may be the case, if the penis is not erect. To do this, apply various ways to stretch the tissue of the foreskin. Stretching can be done:

• manual method;
• with the help of specialized expanders.

Manual technique

Manual stretching of the foreskin is held in two main ways:

1. Stretching foreskin by gradually stretching the last on the glans penis. The procedure is best done during bathing, since in the water the foreskin becomes more elastic. Never stretch the foreskin before the onset of pain, this can lead to a worsening of the condition. Also stretching the foreskin with a head can be done during urination, but again, do not bring the stretch to pain.
2. second method consists in introducing into the skin fold or bag preputial foreskin two fingers with subsequent slow dilution. This allows you to stretch the foreskin at a time when the penis is not excited.

Instrumental technique

In addition to manual stretching, there are special medical devices that allow this procedure. One such tool is Glanshi's tool. It has certain limitations - it can be used if only the ring of the foreskin is narrowed by no more than 6 cm. Fig.2 - Glander tool for stretching the foreskin. For

procedure Glanshi end portion with the extension tool is introduced into the ring of the foreskin, and then slowly tool handles are brought together, and wherein the working end diverges and expands the ring. On the handle of the instrument there are special incisions( cremalier), which allow you to conveniently control and fix the force of stretching.

Extension procedure for the foreskin is systematically performed, it is very important for the development of a good effect. For greater efficiency, in some cases, combined conservative treatment is possible. The method is effective only at the earliest stages, and to develop a good and lasting effect one must have patience. Treatment of phimosis without medicinal preparations using manual stretching or Glanshi apparatus takes from several weeks to 3 months.

Drug therapy

For more advanced forms of phimosis, in the II and III stages, the mandatory component of conservative treatment is the use of corticosteroid anti-inflammatory drugs. Apply them locally in the form of ointments long courses.

In modern urological practice, such drugs as

1. Betamethasone have been used. A corticosteroid drug obtained synthetically. Has a higher activity in comparison with its natural counterparts. It also has an anti-inflammatory, local anesthetic effect;
2. Clobetasol. It has an exclusively local effect, so the risk of side effects from this drug is extremely small. It is excellent for long-term systemic therapy of penile phimosis.
3. Budesonide. Analogue of prednisolone, has similar effects. But it is not recommended for long-term use.

The effect of glucocorticosteroids is to increase the elasticity of the prepuce and the faster healing of microcracks and its defects. In the presence of inflammation, topical application of glucocorticosteroids helps to 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 increases the effectiveness of treatment. At the III stage, glucocorticosteroids are also used, however, in case of inefficiency, the expediency of their use is eliminated. Then go to the radical treatment - surgical intervention.

Surgical treatment

Surgery for a variety of forms of phimosis is a radical method, i.e. Leading to a complete cure for the sick man. For surgical treatment, the procedure of circumcision or circumcision is performed. In the people most often the operation is called circumcision. Operative intervention is used in advanced stages of phimosis.

Fig.3 - Circumcision of the foreskin in phimosis.

The foreskin can be resected completely, or partially. The choice of the scope of surgical intervention depends on the patient's wishes and on the degree of the inflammatory process taking place in the external genitalia. If desired, a part of the foreskin can be preserved. In this case, the sensitivity of the glans penis will be partially preserved at the preoperative level, since it will remain covered with the remaining part of the prepuce.

Intervention is always associated with a small risk of intraoperative complications: bleeding or an anaphylactic reaction to anesthesia. The most common complications are associated with secondary infection during recovery from surgery. Immediately it is worth mentioning that complications can be avoided if all the recommendations of the treating doctor are met and the intimate hygiene is carefully observed.

See "Pros and cons of circumcision."

Complications of phimosis

Fig.4 - Paraphimosis is the most frequent complication of phimosis.

Paraphimosis - infringement of a head of a sexual member by the narrowed ring of a prepuce. In this case, there is a significant reduction in trophism( nutrition) of the head, which leads to its necrosis and the occurrence of purulent complications. The clogged head swells, and its position is aggravated. Paraphimosis is the reason for an emergency intervention.

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