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.
There is a need to have a proper diagnosis before any decisions on treatment can be arrived at. This is largely a clinical diagnosis with laboratory and radiological investigations only playing a minor role. Naturally occurring adhesions between the glans penis and the prepuce are responsible for the majority of cases of phimosis. This category is therefore also known as physiological phimosis. It can be distinguished from pathological phimosis occurring due to disease processes.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
There are a number of reasons as to why circumcision may not be preferred by a number of parents. One of them is cultural practices where the parents are against the practice as a cultural belief and would only have it if there were no other options available. Some patients may have genital malformations such as epispadias and hypospadias for which the foreskin is used in surgical correction. The foreskin cannot, therefore, be removed before this operation.
Dilatation and stretching is a fairly easy procedure to carry out. As the name suggests, it entails the stretching of the foreskin so that it can be retracted easily. A local anaesthetic agent is usually required to minimize the pain. This procedure is cheaper than the traditional circumcision technique yet quite effective. The main disadvantage is that phimosis may recur.
Dilation and stretching of the prepuce is a commonly performed alternative. This procedure can be easily carried out by a doctor in an outpatient department. Advantages include that it is cheap, effective, less painful and quite safe. It is usually carried out after applying local anaesthetic agent into the prepuce. The technique may not work that well in the presence of fibrosis or infection.
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.
Circumcision is an important procedure as relates to the management of phimosis. It has been the first line mode of intervention for many years but this has been changing in recent times. Some of the contributing factors are the cost, associated risks and complexity. Several alternatives now exist. Parents should be educated on these alternatives and allowed to make decisions based on the merits and demerits of each.
There is a need to have a proper diagnosis before any decisions on treatment can be arrived at. This is largely a clinical diagnosis with laboratory and radiological investigations only playing a minor role. Naturally occurring adhesions between the glans penis and the prepuce are responsible for the majority of cases of phimosis. This category is therefore also known as physiological phimosis. It can be distinguished from pathological phimosis occurring due to disease processes.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
There are a number of reasons as to why circumcision may not be preferred by a number of parents. One of them is cultural practices where the parents are against the practice as a cultural belief and would only have it if there were no other options available. Some patients may have genital malformations such as epispadias and hypospadias for which the foreskin is used in surgical correction. The foreskin cannot, therefore, be removed before this operation.
Dilatation and stretching is a fairly easy procedure to carry out. As the name suggests, it entails the stretching of the foreskin so that it can be retracted easily. A local anaesthetic agent is usually required to minimize the pain. This procedure is cheaper than the traditional circumcision technique yet quite effective. The main disadvantage is that phimosis may recur.
Dilation and stretching of the prepuce is a commonly performed alternative. This procedure can be easily carried out by a doctor in an outpatient department. Advantages include that it is cheap, effective, less painful and quite safe. It is usually carried out after applying local anaesthetic agent into the prepuce. The technique may not work that well in the presence of fibrosis or infection.
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.
Circumcision is an important procedure as relates to the management of phimosis. It has been the first line mode of intervention for many years but this has been changing in recent times. Some of the contributing factors are the cost, associated risks and complexity. Several alternatives now exist. Parents should be educated on these alternatives and allowed to make decisions based on the merits and demerits of each.
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