Phimosis: Difference between revisions
WikiModEn2 (talk | contribs) Add information on circumcision. |
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|pubmedCID=2051968 | |pubmedCID=2051968 | ||
|DOI=10.1136/bmj.2.4642.1433 | |DOI=10.1136/bmj.2.4642.1433 | ||
|accessdate= | |accessdate=2019-11-02 | ||
}}</ref> The inner surface of the foreskin of a newborn baby is fused by a [[synechia]] to the surface of the glans penis so that is non-retractable.<ref>{{REFjournal | }}</ref> The inner surface of the foreskin of a newborn baby is fused by a [[synechia]] to the surface of the glans penis so that is non-retractable.<ref>{{REFjournal | ||
|last=Deibart | |last=Deibart | ||
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|DOI=https://doi.org/10.1002/ar.1090570409 | |DOI=https://doi.org/10.1002/ar.1090570409 | ||
|accessdate=2019-11-01 | |accessdate=2019-11-01 | ||
}}</ref> Moreover the tip of the foreskin at birth is usually too tight to permit any retraction.<ref name="gairdner1949" /> Thus normal, natural childhood non-retractable foreskin has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults. | }}</ref> <ref name="shahid2012">{{REFjournal | ||
|last=Shahid | |||
|first=Sukhbir Kaur | |||
|author-link= | |||
|etal=no | |||
|title=Phimosis in children | |||
|trans-title= | |||
|language= | |||
|journal=ISRN Urology | |||
|location= | |||
|date=2012 | |||
|volume=707329 | |||
|issue= | |||
|pages= | |||
|url=https://www.hindawi.com/journals/isrn/2012/707329/ | |||
|quote= | |||
|pubmedID=23002427 | |||
|pubmedCID= | |||
|DOI=10.5402/2012/707329 | |||
|accessdate=2019-11-02 | |||
}}</ref> Moreover the tip of the foreskin at birth is usually too tight to permit any retraction.<ref name="gairdner1949" /> Thus normal, natural childhood non-retractable foreskin, which must be distinguished from pathological phimosis,<ref name="shahid2012" /> has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults.<ref name="shahid2012" /> | |||
Physiological phimosis can be divided into three main categories - symptom-free, in need of therapy, and in need of surgery. | Physiological phimosis can be divided into three main categories - symptom-free, in need of therapy, and in need of surgery. | ||
From a medical standpoint, an otherwise symptom-free [[phimosis]], even after dissolution of preputial adhesions, does not require any treatment before the child enters puberty. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point. | From a medical standpoint, an otherwise symptom-free [[phimosis]], even after dissolution of preputial adhesions, does not require any treatment before the child enters puberty. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point. | ||
Even though the data from Jakob Øster's studies have been known for 51 years,<ref name="Øster1968">{{REFjournal | Even though the data from Jakob Øster's studies have been known for 51 years,<ref name="Øster1968">{{REFjournal | ||
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}}</ref> some check lists for school doctors‘ examinations still erroneously refer to physiological phimosis as an abnormality. | }}</ref> some check lists for school doctors‘ examinations still erroneously refer to physiological phimosis as an abnormality. | ||
In most cases, only watchful waiting is necessary, not surgery or other treatment. | In most cases, only watchful waiting is necessary, not surgery or other treatment. Parental reassurance is the only treatment required.<ref name="shahid2012" /> | ||
By age 10.4 years, about 50 percent of intact boys have a retractable foreskin.<ref name="Øster1968" /> <ref name-"thorvaldsen2005">{{REFjournal | By age 10.4 years, about 50 percent of intact boys have a retractable foreskin.<ref name="Øster1968" /> <ref name-"thorvaldsen2005">{{REFjournal | ||
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}}</ref> Most of the rest develop a retractable foreskin in their teenage years.<ref name="Øster1968" /> | }}</ref> Most of the rest develop a retractable foreskin in their teenage years.<ref name="Øster1968" /> | ||
If treatment is deemed necessary, the application of topical steroid ointment is the most cost-effective treatment.<ref>{{REFjournal | If treatment is deemed necessary, the application of topical steroid ointment is the most cost-effective treatment.<ref name="vanhowe1998">{{REFjournal | ||
|last=Van Howe | |last=Van Howe | ||
|first=Robert S. | |first=Robert S. | ||
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|accessdate=2019-11-01 | |accessdate=2019-11-01 | ||
|format= | |format= | ||
|quote=The foreskin never retracts, and nor does it cause any kind of problem while having intercourse or masturbating. I have been | |quote=The foreskin never retracts, and nor does it cause any kind of problem while having intercourse or masturbating. I have been enjoying a very healthy sex life with my girlfriend since the last two years. | ||
}}</ref> | }}</ref> | ||
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If after a failed attempt to stretch the foreskin with corticosteroid cream a surgical intervention is necessary, a preputioplasty is always to be preferred over classic circumcision, due to its lower morbidity, lower rate of complications and lower costs. | If after a failed attempt to stretch the foreskin with corticosteroid cream a surgical intervention is necessary, a preputioplasty is always to be preferred over classic circumcision, due to its lower morbidity, lower rate of complications and lower costs. | ||
==Circumcision== | ===Circumcision=== | ||
Circumcision is the classic treatment for phimosis, but has many disadvantages and drawbacks. Circumcision is less performed today. | Circumcision is the classic treatment for phimosis, but has many disadvantages and drawbacks. Circumcision is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" /> | ||
* Circumcision is the most expensive treatment. | * Circumcision is the most expensive treatment.<ref name="vanhowe1998" /> | ||
* Circumcision has a long, painful, and difficult recovery. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound. As with other surgery, complications are surgical misadventure, hemorrhage, and infection. | * Circumcision has a long, painful, and difficult recovery. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound. Sexual and psychological issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and infection. Loss of the penis and death is rare.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal | ||
|last=Williams | |||
|first=N | |||
|author-link= | |||
|last2=Kapila | |||
|first2=L | |||
|author2-link= | |||
|etal=no | |||
|title=Complications of circumcision | |||
|trans-title= | |||
|language= | |||
|journal=Brit J Surg | |||
|location= | |||
|date=1993 | |||
|volume=80 | |||
|issue= | |||
|pages=1231-6 | |||
|url=Complications of circumcision | |||
|quote= | |||
|pubmedID=8242285 | |||
|pubmedCID= | |||
|DOI=10.1002/bjs.1800801005 | |||
|accessdate=2019-11-02 | |||
}}</ref> | |||
* Circumcision permanently and irreversibly amputates the foreskin, so its multiple protective, immunological, sensory, and sexual functions are destroyed. | * Circumcision permanently and irreversibly amputates the foreskin, so its multiple protective, immunological, sensory, and sexual functions are destroyed. | ||
* Many men report a permanent loss of sexual sensation. | * Many men report a permanent loss of sexual sensation. | ||
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* Elongation of the frenulum with a skin graft. | * Elongation of the frenulum with a skin graft. | ||
Circumcision is not appropriate or necessary to treat frenulum breve. Patients must be careful when consulting a urologist, because urologists earn a nice fee from performing a circumcision, so may be quick to recommend circumcision to an unwary patient. | Circumcision is not appropriate or necessary to treat frenulum breve. Patients must be careful when consulting a urologist, because urologists earn a nice fee from performing a circumcision, so may be quick to recommend inappropriate and un-necesary injurious circumcision to an unwary patient. | ||
{{SEEALSO}} | {{SEEALSO}} | ||