Phimosis Treatmentin Nagpur: Know the Methods

Phimosis is a condition in which the foreskin of the penis (the male sex organ) cannot be retracted. This leads to painful urination and erections. Most boys are born with this condition. It is known as physiologic phimosis and usually resolves on its own by age 5. In older boys and adult men, phimosis results from injuries and bacterial infection. This is known as pathologic phimosis and requires treatment in the form of topical steroid creams and surgery in Nagpur.

Phimosis is a condition in which the prepuce (foreskin) of the penis cannot retract. This condition is frequently seen in kids but is also common in adults. Phimosis leads to the appearance of rings around the penis and causes symptoms like pain during urination and erection. Phimosis is not seen in men who are circumcised.
The prepuce is tight when the baby is born and gradually loosens up. By the time the baby is 2 years old, the pouch loosens up, and it can be fully retracted by age 5. This is a normal phenomenon and is known as physiologic phimosis.
In older boys and men, infections of the penis and injuries can damage the prepuce. It leads to painful urination and erections. This type of phimosis seen in men and older boys requires treatment in Nagpur as it does not resolve on its own. It is known as pathologic phimosis.

Phimosis affects uncircumcised males. It is more common in older boys than in men. In older boys, phimosis has the following reasons for development:

• Repeated urinary tract infection
• Injury to the foreskin
• Infection of the foreskin 
• Trauma to the penis and foreskin

In older men, phimosis can happen due to the following reasons:

• Sexually transmitted diseases like Syphilis, Gonorrhea, Trichomoniasis, Chlamydia, and Hepatitis C
• Eczema (a skin disorder that causes thick, itchy skin)
• Psoriasis(an autoimmune skin disease that leads to flaky, itchy skin)
• Lichen sclerosis(a condition that affects the genital region causing patchy, discolored and thin skin)
• Infections of the penis and foreskin
• Poor hygiene
• Type II Diabetes Mellitus (a condition in which the body does not use insulin properly, resulting in increased blood sugar levels)

Most kids with phimosis do not experience any symptoms. Adults with phimosis also do not experience any symptoms. In severe cases when the prepuce completely covers the tip of the penis, there may be symptoms like-

• Pain and swelling of the tip of the penis and foreskin
• Strong, foul-smelling odors from the penis
• Painful urination. The act of urination is messy due to the tightness of the foreskin.
• The foreskin may swell up during urination, known as the ballooning effect
• Discharge of pus and blood from the penis
• Pain during sexual activities
• Infection of the foreskin and tip of the penis

A clinical evaluation is the best way to diagnose phimosis. A urologist (a doctor specializing in diseases of the urinary tract and male reproductive system) will manage phimosis. Your doctor will thoroughly examine the penis to arrive at the diagnosis.

Additional tests to help understand the reasons for the development and any underlying medical disorders may be advised by your doctor:

• A urine test to check for the presence of bacteria and pus cells in the urine
• Swab tests to check the cause of infection present in the foreskin
• Blood and urine tests to check for your sugar levels, as phimosis is a potential risk factor for diabetes type II
• Blood and urine tests to check for the presence of STDs like Syphilis, Gonorrhea, Trichomoniasis, Chlamydia, and Hepatitis C.

Circumcision is the surgery performed in children not responsive to conservative treatment for phimosis. Circumcisions are usually done by a pediatrician (a doctor who treats children), a urologist, or a surgeon. In most young boys, surgery is only required when medical treatments have failed to relieve the symptoms. Complete or partial circumcision will be recommended by the surgeon in Nagpur depending on the condition of the child. 

• Partial Circumcision- In this procedure, the topmost part of the foreskin is only removed, sparing the bottom of the penis head (the foreskin surrounds that). It involves making a small cut on several places of the foreskin to be loosened and retracted easily. This is done as a daycare procedure under general anesthesia. Your child will recover from the surgery in 3 to 4 days. Younger kids and babies recover faster. The surgeon will prescribe medicines to help your child with the pain, swelling, and bruising.
• Complete/ total Circumcision- This procedure involves removing the entire foreskin and can be done in children and adults. This is usually resorted to as a last step when all forms of treatment have failed. A surgeon can use many techniques and approaches for performing complete circumcision. Some of the most common ones are:
  • Conventional circumcision-In this procedure, the surgeon removes the entire foreskin using different techniques like the dorsal slit, forceps-guided, and sleeve resection. They all remove the foreskin entirely.
  • Silicone Rings-This method makes use of special devices called silicone rings. It is a quick, safe, and effective method of circumcision and can be performed even by surgeons with less expertise.
  • Stapler Circumcision- This is the latest method developed by ZSR Biomedicals, now being used universally. It involves using a special stapler that is fitter over the penis. In one quick motion, the foreskin is removed, and the skin edges are sealed with staple pins instead of sutures as in the conventional method.
  • Laser circumcision- This is one of the advanced procedures. In this procedure, the surgeon uses high-beam lasers to cut off the foreskin. There is no bleeding, and the wound edges are clean. The surgery takes only 15 to 20 minutes to get completed. There is minimal postoperative pain, and the recovery period is much less than in other surgeries.

Recovery From Surgery

The recovery time from circumcision varies depending on the type of procedure performed. All procedures are daycare procedures, meaning you or the child can go home the same day.

• Take complete rest for the initial 24 hours. Though the pain is minimal, the penis may be swollen and appear bruised during the initial days. 
• Avoid showering or swimming for at least a week after the procedure. Wetting the area before proper healing might lead to an infection.
• Drink plenty of water and clear fluids in the first 24 hours of the procedure.
• Avoid strenuous activities such as running or cycling for 2-3 weeks after the procedure.
• Wear loose and comfortable underwear during the healing period and keep the dressing on the area till the doctor’s advice.
• Take the medications as prescribed by the doctor.
• You will have an appointment with your surgeon after 3 weeks of surgery. The bandages will be removed, and the wound will be examined for signs of bleeding and infection. Once cleaned, the wound is left open. Depending on the technique, your silicone ring or staples will fall off on their own after 10 to 14 days once the incision has healed.
• You may return to your daily routine a few days after the procedure. Complete recovery from the surgery takes 2 to 3 weeks, during which you have to avoid strenuous activities like running or lifting heavy weights, sexual intercourse, and masturbation.

Phimosis does not cause any symptoms in young boys. They usually grow out of this condition. In adults, there may be several symptoms that, if not addressed, lead to complications. 

• Paraphimosis- This is a condition where the foreskin gets stuck and cannot go back to its original position. This is a medical emergency that requires immediate attention.
• Phimosis is a risk factor for developing type II diabetes mellitus
• Phimosis may make it difficult for you to indulge in sexual activities
• If left untreated, your foreskin may become heavily infected, leading to gangrene. In such cases, your surgeon may suggest amputating your penis.
• Circumcision of the foreskin also causes complications like scarring, excessive bleeding, and infection.
• It has been seen that a tight foreskin may encourage the development of penile tumors. However, this is a topic that needs further research.

Prevention is better than cure. This stands true for phimosis too. Penile hygiene is a simple and easy way to prevent phimosis.

• Wash your penis, foreskin, and the area underneath the foreskin with lukewarm water and mild soap during your bath time. Also, wash and dry well each time you visit the loo.
• Gentle retraction of the foreskin should be practiced regularly. You may use coconut oil that acts as a lubricant. This helps keep the prepuce's skin loose and helps avoid infections.
• Young boys and babies will have a foreskin attached to the penis. This is a normal occurrence. The foreskin becomes retractable around 5 years of age. As a parent, do not try to pull back the foreskin forcibly. You may end up causing harm.
• Use a mild, non-perfumed soap while bathing your baby. Apply mild talcum powder on the private parts to avoid itching and irritation.

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