Post Date December, 02 2023
Children with phimosis and redundant foreskin are congenital. When a child begins normal metabolism and secretion after birth, and phimosis or excessive foreskin length has a certain impact on urination, especially when phimosis exists, the foreskin will bulge like a balloon during urination. After urination, there is often a small amount of residual urine in the foreskin cavity, coupled with accumulated lipid and epithelial desquamation, which will gradually form massive foreskin scale, which is a good medium for bacterial reproduction. Chronic irritation that exists for a long time can cause inflammation of the foreskin and form balanitis. Repeated attacks can cause adhesions in the foreskin cavity. Due to the presence of foreskin scale, urine is often in the form of swirling pits, which are slowly and thinly excreted as hair, often resulting in poor urination as people age.
The treatment of phimosis and adhesions of the foreskin can be performed at various ages of the child, such as newborn and infancy (<1 year old), early childhood (1-3 years old), preschool (3-7 years old), and school-age (7-15 years old). If some infants have no urine two or three days after birth, the outer mouth of the phimosis is like a pinhole, accompanied by lipid contamination closure. After dilation of the phimosis, the dirt was peeled off, and urination was unobstructed after washing. Some children also form foreskin scaling due to phimosis, forming one or more nodules under the skin of the glans, which are soft or hard, without local redness or exudation. During urination, the foreskin cavity is filled like a ball, and the foreskin scaling is expanded, separated, and peeled off. After removing the scaling stone, sometimes it can be seen that the compressed area of the penis and glans foreskin is pale and uneven, and the glans development is often limited.
If there is no adhesion, manual treatment can be used. After disinfection, anesthesia with 2% dicaine is used to expand the prepuce opening until it can be turned up. The prepuce orifice can be expanded using either an injection inflatable method or an expansion tube (ureteral catheter). If there is adhesion, it can be separated simultaneously. If the adhesion is severe, use a ball probe to separate it until the prepuce is completely inverted, exposing the glans and frenulum, peeling off the scale or stone from the prepuce, and then rinse with physiological saline. Disinfect with 1 ‰ chlorhexidine. Apply lubricating pain relief ointment to the prepuce cavity to prevent re adhesion. Reset the prepuce. Instruct to frequently turn over the foreskin and wash the foreskin to relieve the trouble caused by phimosis. After separation, there may be prepuce edema within a few days, which can disappear after soaking with warm saline. If there is adhesion again, the same method can be used for slight treatment. This non surgical treatment is non bleeding, non infectious, and does not require stitches to be removed, making it easy for both children and their families to accept.
Circumcision can be used to treat severe adhesions of the foreskin due to the adhesion of the inner plate of the foreskin to the coronal sulcus and glans. This is the result of repeated episodes of foreskin balanitis, which causes a large amount of inflammatory exudation and causes adhesion after absorption. During surgery, careful separation is necessary, otherwise there may be variations in the appearance of the glans. In some patients, the pigmentation of the glans skin may vary in depth and appear as freckles after separation.
Although circumcision is a small outpatient operation, it can also cause adhesions if not handled carefully. This is due to excessive retention of the skin on the penis during the operation, which leads to adhesion beyond the coronal sulcus and outside the glans after the operation. The vast majority of postoperative adhesions do not affect sexual life, nor do they produce inflammation and malignant changes, so there is no need to worry. If adhesion causes an abnormal erection of the penis and affects sexual life, additional surgery should be performed. Adhesion needs to be carefully separated and, if necessary, additional plastic surgery should be performed.
(Intern Editor: Cai Junyi)
