Phimosis:
In
phimosis the foreskin cannot be retracted over the glans to the
coronary sulcus. If the phimosis is not corrected during childhood
the following complications can occur in adulthood even in mild
cases:
- Balanitis
- Preputial
stones
- Penile
cancer
- Paraphimosis
Since
the preputial sac can not be cleaned daily, secretions are retained
and infections occur (=balanitis). This causes scar formation
of the mucous membrane and thereby worsens the degree of the phimosis.
The smegma incrustates and forms soft preputial stones. Due to
chronic inflammation, penile cancer can develop in later life.
Since it originates mostly in the coronary sulcus where it cannot
be seen, the diagnosis is often delayed.
Paraphimosis
If
the narrow foreskin gets retracted during intercourse or
masturbation, it forms a constricting ring at the level of the
coronary sulcus. The venous backflow is interrupted while arterial
inflow continues. The result is a painful edema of the glans and
the mucous membrane which cannot resolve spontaneously. While
the proximal penile shaft remains normal, a constricting ring
develops in the area of the coronary sulcus. A paraphimosis can
also result if after insertion of a catheter the foreskin is not
pulled back over the glan.
Therapy
Compression
of
the glans for 3-5 minutes with simultaneous massage until
the edema resolves and the glans can be pushed back under the
foreskin. In longstanding or severe paraphimosis a dorsal slit
of the constricting ring is performed.
Rule
A
foreskin that is too narrow (=phimosis) should be treated by circumcision
during childhood.
Treatment
for paraphimosis consists of manual reduction or dorsal slit.
Elective circumcision is performed after incision of the constricting
ring and after the edema is resolved.
