In the article we will 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 an abnormal narrowing of the foreskin, due to which the head of the penis cannot pass through a narrow opening.
As a result, her exposure is impossible, very painful or difficult. Physiological phimosis is quite common. In almost all boys in the first months of life, the head of the penis does not fully open from the preputial sac. By six months of age, phimosis occurs in 83% of infants. Most boys (90%) have thispathology resolves on its own by 3 years. However, in cases where this has not happened by age 7, phimosis is classified as pathological.
What are phimosis and paraphimosis? This question interests many.
Paraphimosis
Paraphimosis in men is a rather dangerous disease associated with infringement of the glans penis. An unfavorable process develops due to the fact that the foreskin narrows significantly and begins to squeeze the delicate skin of the head. The development of paraphimosis begins after the full retraction 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.
Wounds and ulcers appear on the affected areas, and the strangulated area with paraphimosis acquires a bluish tint and becomes swollen. 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 may be based on the reduction of the head manually or the use of surgical techniques, which is most relevant if the paraphimosis is at an advanced stage. Surgical manipulations include taking a puncture from edematous areas and circular excision of the flesh.
Let's consider the main differences between phimosis and paraphimosis.
How are these pathologies different?
Paraphimosis is a more acute condition when compared to phimosis. It usually develops after phimosis, but in somecases, it can also occur as an independent phenomenon, acting as an unfavorable 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. When the first signs of this pathology appear, a man should consult a doctor. You can provide first aid to yourself by lubricating the head with a greasy cream and trying to push it under the flesh. If this fails, the patient must 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 mellitus;
- 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. Usually, specialists diagnose paraphimosis at 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 cystoscopy or catheter placement is incorrect.
Whendiagnosis of phimosis and paraphimosis in men, their causes may be as follows:
- chronic non-bacterial inflammation of the penis (resulting from dermatological problems, allergic reactions, mechanical abrasions and injuries);
- venereal diseases (primary stages of gonorrhea and syphilis);
- candidiasis;
- penis injuries (often developed 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 boy's he alth. 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, such complications can be eliminated exclusively by surgery, through resection of the foreskin. Phimosis and paraphimosis in children are very common.
If phimosis in children is cured on its own and without radical therapy, then paraphimosis in boys requires an urgent appeal to a surgeon or urologist. Outwardly, it manifests itself as 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 the acute condition will be treated promptly.
It is extremely important that when a child has paraphimosis, help is provided to him very quickly. If appropriate measures are not taken in a timely manner, the 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 part of the child's penis. In addition, ulcers, inflammations and wounds appear on the penis, which are provoked by pathogenic microorganisms that enter the mucous membrane of the prepuce and heads. The outcome of phimosis and paraphimosis in children can be favorable if the foreskin is quickly repositioned.
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:
- Pain in the head of the penis, which increases during touching.
- Rapid development of swelling of the flesh and head.
- Severe urinary retention, painful urination.
The listed manifestations are the primary signs of paraphimosis. With phimosis, the symptoms are approximately the same, only they can be mildly expressed. If they are detected, the patient should immediately contact the surgeon. Otherwise, the disease may go into an advanced stage.
Signs of pathology in advanced stages
In difficult cases with paraphimosis, the symptoms in a man may be as follows:
- the penis is covered with spots, which are the main sign of tissue death;
- development of death of nerve endings, as a result of which a man may not feel pain;
- affected areas of the penis lose sensation;
- the surface of the penis is covered with a hard crust.
- appearance of an unpleasant odor in the genital area;
- blackening of some parts of the penis;
- gangrene of the penis (this symptom almost always occurs in the last stages of paraphimosis);
- Spontaneous amputation of certain parts of the penis (for example, the foreskin).
The last, most difficult stage of this disease is diagnosed quite rarely. As a rule, men go to the hospital when it is still possible to save the penis.
How is the presence of excess foreskin - phimosis and paraphimosis detected?
Diagnostic measures
Diagnosis is carried out on the basis of the patient's complaints. To make a diagnosis, the examination should be carried out by a surgeon or urologist. The specialist determines whether there is a main symptom of the disease - the inability to open the head of the penis with phimosis or, on the contrary, set it in case of paraphimosis. As an auxiliary technique, a patient is interviewed in order to determine the features of the pathology, if we are talking about such a disease in an adult. If the pathology has developed in a child, his parents can provide such data. Treatment of phimosis and paraphimosis should be timely.
Phimosis treatment
Phimosis can be treated in various ways. Non-pharmacological treatment involvesslow stretching of the flesh by hand. Experts recommend pulling it on the head for ten minutes daily. The use of stretching methods, according to experts, has an efficiency of about 80%. Carrying out such procedures is most effective while taking a bath, when the skin becomes elastic. It should be borne in mind that you need to stretch the foreskin until pain appears, without continuing this procedure with the development of pain.
If the flesh is elastic and there are no cicatricial changes, the stretching method is applied, which is carried out using local anesthesia. In addition, flesh plasty is sometimes performed as a surgical technique to increase the size of the preputial 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 to relieve inflammation and swelling, activates wound healing. Surgical therapy for phimosis is used at the third or fourth degree of the development of the disease, when conservative treatment has not given positive results.
Treatment of paraphimosis
Paraphimosis as a complicated form of phimosis suggestssurgical methods of therapy, since it is an extremely acute condition that requires urgent measures to eliminate it. The only treatment for this is surgery to remove the foreskin. In the course of surgical manipulations, adhesions in the preputial sac are separated using a metal probe. If there are scars on the foreskin, then during the operation they are excised. Such operations are usually carried out 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 ranges 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 sooner the wound heals. On the tenth day, it partially heals and dressings can be done once a day.
Pain syndrome after a surgical solution to this problem can be very intense, and this is considered the norm. To stop such discomfort, you can take painkillers.
Prevention of phimosis and paraphimosis is quite simple - it is enough to observe the hygiene of the penis and prevent its injury. In childhood, preventive measures include regular retraction of the foreskin and exposure of the head of the penis.
Reviews about these pathologies
Quite common in menphimosis and paraphimosis. Reviews confirm this. Patients report that if preventive measures are followed, 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.
