Phimosis - Know More About It!

What is Phimosis?

Phimosis is a condition in which the foreskin of the penis cannot be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

Signs and symptoms

At birth, the inner layer of the foreskin is sealed to the glans penis.The foreskin is usually non-retractable in early childhood, and some males may reach the age of 18 before their foreskin can be fully retracted. 

Symptoms

• soreness, itchiness,and odour.
• redness and swelling.
• a buildup of thick fluid. 
• Pain when urinating. 

Severity Score 

Score 1: full retraction of the foreskin, tight behind the glans.

Score 2: partial exposure of glans, prepuce (not congenital adhesions) limiting factor.

Score 3: partial retraction, meatus just visible.

Score 4: slight retraction, but some distance between tip and glans, i.e. neither meatus nor glans can be exposed.

Score 5: absolutely no retraction of the foreskin. 

Causes

There are three mechanical conditions that prevent foreskin retraction:

1. The tip of the foreskin is too narrow to pass over the glans penis. This is normal in children and adolescents.

2. The inner surface of the foreskin is fused with the glans penis. This is normal in children and adolescents, but abnormal in adults. 

3. The frenulum is too short to allow complete retraction of the foreskin (a condition called frenulum breve).

Pathological phimosis (as opposed to the natural-retractability of the foreskin in childhood) is rare and the causes are varied. Some cases may arise from balanitis (inflammation of the glans penis).

Lichen sclerosis et atrophicus (thought to be the same condition as balanitis xerotica obliterans) is regarded as a common (or even the main) cause of pathological phimosis. This is a skin condition of unknown origin that causes a whitish ring of indurated tissue(a cicatrix)to form near the tip of the prepuce. This inelastic tissue prevents retraction. Phimosis may occur after other types of chronic inflammation(such as balanoposthitis), repeated catheterization, or forcible foreskin retraction. Phimosis may also arise in untreated diabetics due to the presence of glucose in their urine giving rise to infection in the foreskin. Phimosis in older children and adults can vary in severity, with some able to retract their foreskin partially (relative phimosis), while others are completely unable to retract their foreskin, even when the penis is in a flaccid state (full phimosis).

TREATMENT - Treating balanitis or another type of infection usually starts with a swab of the foreskin to be studied in a lab. A bacterial infection will require antibiotics, while a fungal infection may require antifungal ointments.If there is no infection or other disease-causing phimosis, and it appears that the tight foreskin is simply a naturally occurring development, there may be several treatment options available. Depending on the severity of the condition, daily gentle retraction may be enough to treat the problem. Atopical steroid ointment can be used to help soften the foreskin and make retraction easier. The ointment is massaged into the area around the glans and foreskin twice a day for several weeks.In more serious cases, circumcision(Surgery) or a similar surgical procedure may be necessary. Circumcision is the removal of the entire foreskin. Surgical removal of part of the foreskin is also possible. While circumcision is usually done in infancy, the surgery can be performed on a male of any age. 

ZSR CIRCUMCISION - ZSR Circumcision is the modern technique of circumcision that is minimally invasive in nature.The stapler like device used for circumcision cuts and seals the edges of the skin. It does not require big incisions on the body and is a painless procedure for the patient. ZSR circumcision also ensures that there is minimal blood loss.ZSR Circumcision is a much simpler and effective procedure than the traditional procedure. Traditional circumcision involves cuts, stitches, and bleeding which prolongs the recovery period for the patient. Also, the chances of complications and discomfort after ZSR circumcision are nil. Whereas the cases of infections and complications after the traditional surgery of circumcision are quite common. So, it is, of course, wise to choose the modern procedure of ZSR circumcision over the old traditional methods.

LASER CIRCUMCISION - The procedure of laser circumcision is a minimally invasive procedure with no bleeding, which makes healing faster and easier. It is a 20-minute procedure and is performed under local, general or spinal anaesthesia. In laser circumcision, the laser cuts through the foreskin. Because of this, the patient has no bleeding or pain during the procedure. 

CIRCUMCISION USING PLASTIC SURGERY SUTURES - In this circumcision is done by removing skin of penis and then approximating skin edges by using absorbable sutures using the plastic surgery technique.