Phimosis is a condition that is characterized by a narrow foreskin of the penis that makes it impossible to retract it behind the glans penis. It is a fairly common problem in male infants. The commonest form of management for the condition is circumcision. Non surgical methods also exist and can be used for some patients. In this article, we will look at the options that can be used to Relieve tight foreskin without circumcision.
A proper diagnosis is essential before a decision to intervene can be made. It is worth noting that up to 96% of all male infants may exhibit some form of non-retractability of the prepuce. The presence of natural adhesions between the prepuce and the glans penis is responsible for most of these cases and thus the condition is termed physiological phimosis. This is different from pathological phimosis which is caused by abnormal conditions such infections and trauma.
The physician needs to determine which of the two types they are dealing with because this will have a bearing on the method of management to be used. The physiological type is often managed conservatively while the pathological type will more often than not require circumcision. Left untreated, the pathological type may persist for months and lead to problems in the entire urinary system.
Even in situations where there are clear indications for circumcision, some parents may decline the procedure for one reason or the other. Commonly, they will cite cultural reasons where the practice goes against their beliefs. More importantly, the procedure may not be appropriate in cases where, the fore skin is required for corrective plastic surgery. This is common for conditions such as epispadias and hypospadias.
Circumcision is at times the right procedure to be undertaken but may not be carried out for one reason or the other. For instance, the parents may decline it on cultural grounds which means that an alternative must be sought. Circumcision is also considered inappropriate when the foreskin is to be preserved for future operations such as the corrective of urethral abnormalities (hypospadias and epispadias).
There are several conservative surgical options other than the traditional form of circumcision. Plastic surgery of the prepuce is one of these procedures. Prepu-tioplasty is a procedure in which a small slit is made on the foreskin either in its upper part or on the side. Others include meatoplasty and frenulotomy. Advantages include quicker recovery, less pain and less cost. Some of the disadvantages are that phimosis can recur.
The use of topical steroids has been readily embraced by many physicians. The success rates of this method range from 65 to 95%. Although the mechanism of action is not well understood, it is believed that it has an effect on local information and may also have some anti immunity properties. A substance known as lipocortin is thought to mediate these actions. The disadvantage is that steroids may cause thinning of the skin.
Phimosis has been treated through circumcision for many years. This has been changing recently for a number of reasons. Some of these reasons include the fact that circumcision is quite costly and is associated with surgical risks. A number of alternatives to circumcision now exist and these offer some advantages. All the alternatives should be considered before a final decision on what is most appropriate is made.
A proper diagnosis is essential before a decision to intervene can be made. It is worth noting that up to 96% of all male infants may exhibit some form of non-retractability of the prepuce. The presence of natural adhesions between the prepuce and the glans penis is responsible for most of these cases and thus the condition is termed physiological phimosis. This is different from pathological phimosis which is caused by abnormal conditions such infections and trauma.
The physician needs to determine which of the two types they are dealing with because this will have a bearing on the method of management to be used. The physiological type is often managed conservatively while the pathological type will more often than not require circumcision. Left untreated, the pathological type may persist for months and lead to problems in the entire urinary system.
Even in situations where there are clear indications for circumcision, some parents may decline the procedure for one reason or the other. Commonly, they will cite cultural reasons where the practice goes against their beliefs. More importantly, the procedure may not be appropriate in cases where, the fore skin is required for corrective plastic surgery. This is common for conditions such as epispadias and hypospadias.
Circumcision is at times the right procedure to be undertaken but may not be carried out for one reason or the other. For instance, the parents may decline it on cultural grounds which means that an alternative must be sought. Circumcision is also considered inappropriate when the foreskin is to be preserved for future operations such as the corrective of urethral abnormalities (hypospadias and epispadias).
There are several conservative surgical options other than the traditional form of circumcision. Plastic surgery of the prepuce is one of these procedures. Prepu-tioplasty is a procedure in which a small slit is made on the foreskin either in its upper part or on the side. Others include meatoplasty and frenulotomy. Advantages include quicker recovery, less pain and less cost. Some of the disadvantages are that phimosis can recur.
The use of topical steroids has been readily embraced by many physicians. The success rates of this method range from 65 to 95%. Although the mechanism of action is not well understood, it is believed that it has an effect on local information and may also have some anti immunity properties. A substance known as lipocortin is thought to mediate these actions. The disadvantage is that steroids may cause thinning of the skin.
Phimosis has been treated through circumcision for many years. This has been changing recently for a number of reasons. Some of these reasons include the fact that circumcision is quite costly and is associated with surgical risks. A number of alternatives to circumcision now exist and these offer some advantages. All the alternatives should be considered before a final decision on what is most appropriate is made.
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