Phimosis is impossibility of retracting the foreskin from around the glans penis. This is a normal physiological condition in young boys as it protects penis and the external urethral opening from trauma and infections. As a rule, physiological phimosis goes away on its own during the first few years of a boy's life. In other cases conventional or even surgical measures are required in order to ensure normal urination and sexual life in the future. Being neglected, the condition causes psychological discomfort as well. Nevertheless, experienced surgeons and urologists offer few options that consider both physical and esthetic aspects.
Etiological factors and clinical manifestations
Physiologic phimosis exists during the first 7 years of boy’s life or somewhat longer. Normally, it does not affect urination or cause discomfort. During the second year of life, the foreskin usually starts separating from the glans. However, in some children even the physiologic phimosis can lead to the development of infectious complications or inflammation. The treatment is prescribed when a child has complaints of pain, swelling of the penis, difficulty urinating (foreskin expands like a balloon when a boy urinates).
A general practitioner or parents can also notice foreskin redness, unpleasant odor or atypical discharge. Such signs are indicative of the balanitis or balanoposthitis. These are bacterial or fungus affection of the penis that often arises in boys with phimosis due to poor hygiene. Balanitis and balanoposthitis require obligatory therapy.
Phimosis can also be new-onset in older children, teenagers or young man. In this situation we talk about acquired or pathologic phimosis. The condition develops against the background of:
- Skin conditions, including eczema, psoriasis, lichen planus and lichen sclerosus
- Foreskin infection, including sexual diseases
- Chronic urinary tract infections
- Mechanical injury of the foreskin
In rare instances, the condition can also arise in the elderly men, due to the loss of skin elasticity with age. The pathologic phimosis always requires treatment as the acquired adhesions between the inner prepuce and glans penis will not dissolve spontaneously.
Conventional treatment options
The main principle of the conventional phimosis treatment is caution. Parents or healthcare professionals should never force the foreskin back, as this may lead to the paraphimosis development. Paraphimosis is a medical emergency that arises when the retracted foreskin cannot be moved back. Patients with paraphimosis require urgent help, as the tight foreskin reduces blood flow in the penis. In addition, forcing the foreskin back leads to rupturing and the subsequent scarring, causes fear and psychological discomfort.
Topical steroids in the form of ointment or cream are often applied for alleviating the foreskin expansion and easier separation of adhesions between the prepuce and glans penis. Applied twice daily for a prolonged time period (at least one month), topical steroids avoid the need for surgical intervention in a number of patients. The most widely used topical steroid is triamcinolone (the trade-names are Kenalog and Triderm). According to the clinical trials results, application of topical steroids is safe and effective option for boys over 3 years old.
In older patients it is recommended to use lubricants and condoms while having sex. Condoms fix the foreskin and lubricants make sexual intercourse more comfortable. This also serves as the paraphimosis preventive measure.
The concomitant therapy for the balanitis or balanoposthitis includes antibiotics (penicillin or erythromycin) or antifungal remedies (miconazole or clotrimazole). Treatment regimen depends on the results of diagnostics, i.e. microscopy of swabs from the surface of the penis and from the urethra.
Treatment of phimosis with circumcision is the most widespread surgical option. During the circumcision, the entire foreskin or its part is removed. The full circumcision is typically performed in infancy, and the partial circumcision may be carried out in a patient of any age. It should be mentioned that the full circumcision has zero risk of the disease relapse, while after the partial one up to 30% of males experience the recurrent symptoms.
Clinics of the countries with the developed healthcare systems offer two types of the anesthetic for the circumcision performing. These are the general anesthetic and the local one. General anesthetic is typically chosen in children. It has more risks than the local one but allows avoiding psychological and emotional trauma. Local anesthetic is chosen in older patients.
Results of a number of clinical trials have demonstrated that circumcised males receive the same satisfaction from the sexual life as the uncircumcised ones. Circumcised men can only have difficulties during the sexual intercourse when the surgery is performed in the adult age.
Other possible intervention is surgical adhesiotomy, which is dissection of natural or pathologic adhesions between the foreskin and glans penis. Being more sparing and safe, adhesiotomy is connected with the higher risk of relapse, as the preserved foreskin may adhere to the glans penis again. Thus, circumcision remains the first-line option in the majority of patients.
Best medical care abroad with Booking Health
While the conservative therapy does not require special technical skills and is connected with few possible complications, surgical interventions are performed in the specialized and highly equipped healthcare institutions. German clinics offer the full range of interventions, as well as the follow-up care and secondary prevention.
Those patients, who do not have experience of treatment in Germany or other foreign country, will benefit from the comprehensive assistance of the certified medical tourism provider Booking Health:
- Selecting the appropriate hospital in Germany or other foreign country (based on the specialization and success rates)
- Booking the appointment with the chosen urologist
- Preparing medical program in advance (consultation, surgical treatment, etc.)
- Providing favorable cost for medical procedures, without overpricing or additional coefficients (saving up to 50%)
- Monitoring treatment program at all stages
- Issuing the insurance in case of complications (а coverage of 200,000 EUR, valid for 4 years)
- Help in buying and forwarding medicines and medical products
- Communicating with the clinic after treatment completion, receiving and translating the reports
- Control of invoices and final calculation
- Organization of additional and control examination
- Offering the highest-level service: booking hotels and tickets, transfer organization
- Offering services of interpreter and personal medical coordinator while staying abroad
Fill in the “Send request” form and wait for the call from an experienced patient case manager or medical advisor.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova