In the article, we consider the clinic, diagnosis and treatment of phimosis and paraphimosis. Phimosis is a congenital pathology of the foreskin in boys. In some cases, such an anomaly can occur independently during puberty, as well as as a result of various injuries and inflammatory processes in the genitals. This disease is characterized by improper narrowing of the foreskin, due to which the head of the penis cannot pass through a narrow hole.
As a result, its exposure is impossible, very painful or difficult. Physiological phimosis is a fairly common occurrence. In almost all boys, in the first months of life, the head of the penis does not open completely from the preputial sac. By the age of six months, phimosis is observed in 83% of infants. In most boys (90%), this pathology resolves by 3 years on its own. However, in cases where this did not happen by the age of 7, phimosis is classified as pathological.
What is phimosis and paraphimosis? This question interests many.
Paraphimosis
Paraphimosis in men is a rather dangerous disease associated with infringement of the glans penis. An adverse process develops due to the fact that the foreskin is significantly narrowed and begins to squeeze the delicate scalp. The development of paraphimosis begins after the complete removal of the flesh behind the coronary sulcus, which changes the blood circulation in the penis and leads to the rapid development of swelling of the penis and tissue necrosis.
In the affected areas, wounds and ulcers appear, and the strangulated area with paraphimosis acquires a bluish tint and becomes edematous. In this case, the foreskin has the form of a dense swollen roller, the patient has problems with urination. Pathology is diagnosed taking into account information from the anamnesis and the results of a visual examination. The course of therapy can be based on manually adjusting the head or applying surgical techniques, which is most important if paraphimosis is at an advanced stage. Surgical procedures include puncture from edematous areas and circular excision of the flesh.
Consider the main differences between phimosis and paraphimosis.
What is the difference between these pathologies?
Paraphimosis is a more acute condition when compared with phimosis. It develops, as a rule, after phimosis, but in some cases it can also occur as an independent phenomenon, acting as an adverse consequence of improper masturbation. If the essence of phimosis is the narrowing of the flesh, then paraphimosis is a more dangerous and complex condition in which a narrow prepuce squeezes the head of the penis.
What is the difference between phimosis and paraphimosis? The main difference is the inability to expose the head of the penis. A man with the appearance of the first signs of this pathology should consult a doctor. You can provide first aid yourself by lubricating the head with a greasy cream and try to push it under the flesh. If this is not possible, the patient should go to a medical facility.
Causes of occurrence
The development of phimosis and paraphimosis begins due to concomitant pathologies and negative external factors, which include:
- diabetes;
- post-traumatic and burn scars;
- systemic skin diseases;
- balanoposthitis;
- balanitis.
Paraphimosis develops as a result of phimosis, if the patient does not take timely measures to eliminate it. Typically, specialists diagnose paraphimosis in the second or third stage of phimosis. The independent occurrence of paraphimosis in adult patients occurs with careless sudden movements during masturbation or sexual intercourse. Varieties of this disease include iatrogenic paraphimosis, which is formed when the cystoscopy is improperly performed or a catheter is placed.
When diagnosing phimosis and paraphimosis in men, their causes may be as follows:
- chronic inflammation of the penis that does not have a bacterial nature (is the result of dermatological problems, allergic reactions, mechanical abrasions and injuries);
- sexually transmitted diseases (primary stages of gonorrhea and syphilis);
- candidiasis;
- member injuries (often develop as a result of inaccurate masturbation);
- balanoposthitis.
In an adult male, pathologies often appear due to a shortened frenulum or dysfunction of the cardiovascular and urinary systems.
In children
Paraphimosis and phimosis, which develop in childhood, pose a serious threat to the health of the boy. The shifted flesh exposes the head of the penis and squeezes it. As a result, there is a rapid development of edema and a serious complication in the form of tissue necrosis. Often eliminating such complications is obtained exclusively by surgery, through resection of the foreskin. Phimosis and paraphimosis in children are very common.
If phimosis in children can be cured independently and without radical therapy, then paraphimosis in boys requires an urgent visit to a surgeon or urologist. Outwardly, it is manifested by a blue head of the organ and its pronounced swelling. Parents by such signs can immediately recognize this disease in their child. In such a situation, they should immediately call an ambulance and take the child to a hospital where surgical treatment of an acute condition will be carried out.
It is imperative that with paraphimosis in a child, help be provided to him very quickly. If appropriate measures are not taken in a timely manner, head tissue will die, irreversible necrotic processes will appear. The consequence of the pathology in this case will be deplorable - the surgeon will have to remove a part of the penis to the child. In addition, ulcers, inflammations and wounds appear on the penis, which are provoked by pathogenic microorganisms that fall on the mucous membrane of the prepuce and head. The outcome of phimosis and paraphimosis in children may be favorable provided that the foreskin is rapidly reduced.
Symptoms
It is impossible not to notice the beginning of the pathological process, since its symptoms are very pronounced. The main manifestations of paraphimosis or phimosis in an adult male are as follows:
- Pain in the area of the head of the penis, which intensifies during touch.
- The rapid development of edema of the flesh and head.
- Severe urinary retention, pain during urination.
The listed manifestations are the primary signs of paraphimosis. With phimosis, the symptoms are approximately the same, only they can be mild. If they are detected, the patient should immediately consult a surgeon. Otherwise, the disease can go to an advanced stage.
Signs of pathology in advanced stages
In complex cases with paraphimosis, the symptoms in a man can be as follows:
- the penis is covered with spots, which are the main sign of tissue death;
- the development of the death of nerve endings, as a result of which a man may not feel pain;
- the affected areas of the penis lose their sensitivity;
- the surface of the penis is covered with a hard crust.
- the appearance of an unpleasant odor in the genital area;
- blackening of some parts of the penis;
- penis gangrene (this symptom almost always occurs in the last stages of paraphimosis);
- spontaneous amputation of individual parts of the penis (for example, the foreskin).
The last, most difficult stage of this disease is rarely diagnosed. As a rule, men go to the hospital when there is still the opportunity to save the penis.
How is the presence of excess foreskin - phimosis and paraphimosis?
Diagnostic measures
Diagnosis is based on patient complaints. To make a diagnosis, the examination should be carried out by a surgeon or urologist. The specialist determines whether the main symptom of the disease is the inability to open the head of the penis during phimosis or, on the contrary, to adjust it during paraphimosis. As an auxiliary technique, a patient is interviewed to determine the characteristics of the pathology, if we are talking about such a disease in an adult. If the pathology has developed in the child, such data can provide his parents. Treatment of phimosis and paraphimosis should be timely.
Phimosis treatment
Phimosis can be treated in various ways. Non-drug treatment involves slow manual stretching of the flesh. Tension it on the head for ten minutes, experts recommend daily. The use of stretching methods, according to experts, has an efficiency of about 80%. Carrying out such procedures is most effective during bathing, when the skin becomes elastic. It should be borne in mind that stretching the foreskin is necessary before the onset of pain, without continuing this procedure with the development of pain.
If the flesh is elastic and there is no cicatricial changes on it, the method of stretching it is applied, which is carried out using local anesthesia. In addition, plastic surgery of the flesh is sometimes performed as a surgical technique in order to increase the size of the prepuce ring without resorting to excision.
Drug treatment of this disease involves the application of corticosteroid ointments to the foreskin and head. Such procedures should be carried out regularly for a long time. Under the influence of such ointments, the elasticity of the skin becomes higher, and it stretches better. Thus, a disease such as phimosis is completely cured. The use of glucocorticoids helps relieve inflammation and swelling, activates wound healing. Surgical therapy of phimosis is used at the third or fourth degree of the development of the disease, when conservative treatment has not yielded positive results.
Paraphimosis treatment
Paraphimosis as a complicated form of phimosis involves surgical methods of therapy, since it is an extremely acute condition that requires urgent measures to eliminate it. The only treatment in this case is surgery to remove the foreskin. In the process of surgical procedures, adhesions are separated in the prepuce bag using a metal probe. If there are scars on the foreskin, then they are excised during the operation. Such operations are usually performed under local anesthesia, and general anesthesia is possible only in childhood.
Recovery period and prevention methods
The duration of the recovery period is quite individual: the rehabilitation period is from 2 weeks to 2 months. In children and young patients, the recovery period is approximately one month, due to regenerative processes: the younger the patient, the faster the wound heals. On the tenth day, it partially heals and dressings can be carried out once a day.
Pain after an operative solution to this problem can be very intense, and this is considered the norm. To stop this discomfort, you can take painkillers.
Prevention of phimosis and paraphimosis is quite simple - it is enough to observe the hygiene of the genital organ and prevent its trauma. In childhood, preventive measures include regular postponement of the foreskin and exposure of the head of the penis.
Reviews about these pathologies
Phimosis and paraphimosis are quite common in men. Reviews confirm this. Patients report that by following preventive measures, surgery can be avoided. In any case, it is better not to delay the visit to the doctor.
From the article we learned how the diagnosis and treatment of phimosis and paraphimosis are carried out.