Phimosis: Difference between revisions

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A [[Adolescent and adult circumcision| circumcision]] may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving [[preputioplasty]] are promising (for example with chronic [[balanitis xerotica obliterans]]) or have failed in previous attempts.

==Pathological phimosis==

== ~~Short frenulum (frenulum breve) ==~~

If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the foreskin. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.

[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.

~~To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.~~

~~There are 3 surgical variants:~~

~~<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref>~~

* Frenectomy, the complete removal of the frenulum

* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically

* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.

~~==Pathologic~~ phimosis==

Pathologic phimosis is phimosis caused by lichen sclerosis et atrophicrus (LSA), formerly known as [[balanitis xerotica obliterans]] (BXO), on the [[foreskin]].<ref name="rickwood1980">{{REFjournal

|last=Rickwood

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Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" />

== Short frenulum (frenulum breve) ==

[[Frenulum breve]] may prevent retraction and may be mis-diagnosed as phimosis

If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the [[foreskin]]. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.

[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.

To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.

There are 3 surgical variants:

<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref>

* Frenectomy, the complete removal of the frenulum

* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically

* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.

==Video==

@@ Line 553: / Line 553: @@
 A [[Adolescent and adult circumcision| circumcision]] may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving [[preputioplasty]] are promising (for example with chronic [[balanitis xerotica obliterans]]) or have failed in previous attempts.
+==Pathological phimosis==
-== Short frenulum (frenulum breve) ==
-If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the foreskin. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.
-[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.
-To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.
-There are 3 surgical variants:
-<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref>
-* Frenectomy, the complete removal of the frenulum
-* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically
-* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.
-==Pathologic phimosis==
 Pathologic phimosis is phimosis caused by lichen sclerosis et atrophicrus (LSA), formerly known as [[balanitis xerotica obliterans]] (BXO), on the [[foreskin]].<ref name="rickwood1980">{{REFjournal
   |last=Rickwood
@@ Line 618: / Line 601: @@
 Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" />
+== Short frenulum (frenulum breve) ==
+[[Frenulum breve]] may prevent retraction and may be mis-diagnosed as phimosis
+If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the [[foreskin]]. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.
+[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.
+To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.
+There are 3 surgical variants:
+<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref>
+* Frenectomy, the complete removal of the frenulum
+* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically
+* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.
 ==Video==