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.
