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March 9, 2012
The phymosis is a state, characteristic of men, at which it is impossible to bare a balanus. This state can be as normal, that is physiological, that and abnormal – pathological. Also the phymosis at boys can be divided on inborn and acquired.
Most often the inborn phymosis is diagnosed for men. At the birth at boys the physiological phymosis, that is impossibility of shift of a prepuce completely and exposures of a balanus, takes place in 96% of cases. Only four percent of boys are born with a prepuce, mobile to such an extent that the head of a penis opens completely. Gradually the situation is leveled, and by six months at twenty percent of boys the balanus can be opened. At three-year age already in 90% of cases the phymosis disappears, and approximately to six-year age this state passes independently practically at all children.
A little differently the situation with the acquired phymosis or a situation when the prepuce lost elasticity because of diseases and injuries is.
The phymosis at boys is expressed by the main symptom – impossibility to bare and remove a penis head. In certain cases this state does not cause in boys of complaints, however rather often children with a phymosis have problems with an urination. So, in the course of an urination the boy can strongly make an effort, show noticeable concern. As a result of urine of the child gets into a preputial cavity. It is inflated, and urine passes drops or a squirt through a narrow opening.
Sometimes inflammatory process which symptoms is pain in the field of a head of a penis and a prepuce, emergence of purulent discharges from a prepuce opening joins a phymosis. At the patient lymph nodes increase, body temperature grows. If the paraphimosis takes place, in the restrained head of a penis acute pains, a head of the member are shown to become more and is expressed becomes blue. In this case the patient needs to give acute management.
At a phymosis adult men sometimes have complaints to the problems with a potentiality arising as psychological discomfort in view of morbidity in the course of sexual intercourse.
The phymosis can be shown as a result of an injury of a penis and the subsequent formation of cicatricial fabric. As a result the prepuce is narrowed, and at the man the cicatricial phymosis is shown. Inflammatory process of a prepuce of a penis (balanoposthitis) can also become the reason of the acquired phymosis. Owing to this disease hems are also formed, and at the patient the phymosis is shown. Sometimes the genetic favor to emergence of a phymosis as a result of insufficient quantity of an elastic component of connecting fabric in a human body is the reason of a phymosis
Classification of a phymosis
Now it is accepted to allocate four degrees of a phymosis. At the first degree it is possible to open a balanus exclusively at rest. If to try to bare a penis head during an erection, the person will feel pain, besides it is difficult to make it.
At the second degree of an illness at rest it is difficult to remove a head, and during an erection the head of the member does not open at all. Lack of an opportunity to open a penis head is characteristic of the third degree of a disease, or it only partially opens in a quiet state. The fourth degree of a phymosis – the heaviest: in this case the penis head does not open at all that considerably complicates process of an urination. Urine at the person is emitted with drops or very thin stream.
Except already described stages also the phymosis relative is allocated. In this state noticeable narrowing of a prepuce becomes exclusive during an erection.
Manifestation of pain which is mainly shown in the course of an erection at a prepuce tension on a penis head is characteristic of a phymosis of the first and second degree. At a phymosis of the third and fourth degree there is no pain, as a rule, the sizes of a preputial ring are insignificant and, therefore, there is no opportunity to bare a head of the member.
At patients with a phymosis even at rather small narrowing of a prepuce after the beginning of active sex life the state can worsen and after a while lead to the fact that the balanus will not be able to open in general. The matter is that in process of the sexual intercourse or masturbation the mucous membrane is injured, and microtears are formed. On site such anguishes small hems are formed over time that as a result does fabric unreceptive to extension, and the phymosis amplifies.
Complications of a phymosis
If at the patient the expressed phymosis takes place, at it the smegma — a zhiropodobny secret which is allocated by prepuce glands can stagnate. This liquid becomes a medium in which different bacteria breed. As a result owing to such situation inflammatory process develops. Even not expressed phymosis is premises for amassment of a smegma and, as a result, manifestation of problems of hygienic character.
At patients with a phymosis of the fourth degree the prepuce is narrowed as much as possible, and obstacles for normal outflow of urine appear. As external manifestations of narrowing there is an inflating of a prepuce and penetration of urine on drops. In this case serious failures in the mechanism of outflow of urine form ostatochno and, as a result, at the patient complications of infectious character in an urethra can develop.
One more complication arising at patients with a phymosis — a paraphimosis. The infringement of a head of a penis the narrowed prepuce is characteristic of such state. The paraphimosis can be shown if the person tries to bare a penis head, in the course of sexual intercourse or masturbation. Owing to such infringement the hypostasis of a balanus conducting to the fact that after a while it is back already impossible to set it begins. There are posineny heads, it becomes very painful. Therefore, at a paraphimosis the emergency intervention of specialists is necessary. In certain cases rather usual reposition of a head manually. However if hypostasis is strongly expressed, the patient should perform operation during which the prepuce is dissected or its leaves are excised.
Also because of prepuce injuries at patients with a phymosis complications of inflammatory character can develop. Injuries, and also accumulation of a smegma in a preputial bag lead to manifestation of a balanoposthitis (inflammatory process of a head and prepuce of a penis). Display of pain and itch near a penis head is characteristic of this state. At patients with a phymosis of the third or fourth stage the prepuce can grow to a balanus. Owing to close contact there is an epithelial pasting of a head and internal leaf of a prepuce. Thus, unions (synechia) are shown. Depending on that, how long there are these unions, relations of a head and prepuce are strengthened. It is possible to treat a similar state only by a surgical method.
Among complications of a phymosis the most serious consequence is the penis cancer. As the reason of the similar phenomenon consider long stagnation of a smegma in a preputial bag. It is proved that most of the people having a penis cancer had an inborn phymosis.
Diagnosis of a phymosis
Diagnosis is carried out on the basis of complaints of the patient. To establish the diagnosis, the doctor-surgeon or the urologist has to perform inspection of the patient. At first inspection of the patient in the course of which the specialist defines whether the main symptom takes place — lack of an opportunity to remove a penis head is performed. As an auxiliary method conduct survey of the patient with the purpose to define features of a disease.
Treatment of a phymosis
It is possible to treat a phymosis by different methods. Nemedikmentozny therapy assumes gradual extension of a prepuce manually. To pull a prepuce on a head of the member for five-ten minutes doctors recommend to make every day. Use of methods of extension of a prepuce, by estimates of specialists, gives efficiency about 75%. It is the best of all to carry out similar procedures during reception of a bathtub, then skin becomes more elastic. It is necessary to consider that it is necessary to delay a prepuce before emergence of the first pain, without continuing to do this procedure with pain at all.
If the prepuce is rather elastic and on it there are no cicatricial changes, the prepuce stretching method is sometimes applied. This procedure is carried out with use of local anesthesia. Also as a surgical method carrying out plastic surgery of a prepuce is sometimes applied to increase diameter of a preputial ring, without applying at the same time circumcision.
Medicamentous therapy of a disease assumes treatment by means of drawing on a head of a penis and a prepuce of corticosteroid ointments. Similar procedures should be made regularly and throughout a long time. Under the influence of ointments elasticity of fabric of a prepuce becomes higher therefore it stretches better. Thus, the phymosis can be cured. Also use of glucocorticoids promotes removal of an inflammation and hypostasis, activates healing of microcracks.
Surgical treatment of a phymosis will be applied to treatment of a phymosis of the third or fourth degree now. This method is reasonable only if all methods described above did not bring desirable result. A phymosis at boys by a surgical method treat, making separation of commissures of a preputial bag with use of the help of a metal probe and gauze tupfer.
If on a prepuce hems take place, then in the course of operation make their excision. Use of a surgical method is effective for 99-100%. As a rule, operations are performed with a local anesthesia, the general anesthesia is possible only at the request of the patient. Surgeons distinguish two types of a phymosis: hypertrophic, with the extended and hypertrophied prepuce, and also atrophic when the prepuce differs in very thin skin which is strongly covering a penis head. Both forms of a phymosis can be cured by means of operations of different types. So, the surgery in the course of which three slits and cross sewing together are made is possible. One more type of operation — circular circumcision. In this case the prepuce is removed, and emergence of a phymosis becomes impossible. However it is necessary to consider that at similar operative measures complications are possible, as well as at any other operations.
Prevention of a phymosis
As prevention of a phymosis it is necessary to follow the rules of hygiene of a penis. In this case important not less than two times a day to displace skin of a prepuce and to wash a penis head with clear water. Not to exchange hygiene is important for prevention of a phymosis at newborn boys. To warn penis head inflammations, it is recommended to bathe the child in grass broths, using the medicinal plants having possessing antibacterial and antiinflammatory properties. Broth of a camomile, a calendula, train will be suitable for this purpose. As a folk remedy for the adult men having certain problems with procrastination of a prepuce it is recommended to do local trays, lowering for twenty minutes a penis in broth of herbs and delaying at the same time a prepuce.
Section: Andrology (Man's diseases) F