Post Date December, 03 2023
A young male patient with nephrotic syndrome was treated with a standard dose of prednisone. Urinary protein quickly turned negative, but it was easy to relapse. Each relapse was often accompanied by symptoms of urinary tract infections such as frequent urination and urgency. Using norfloxacin was effective, but it would recur soon after stopping the drug. Upon careful examination, the patient originally had an excessively long foreskin. Let's talk about what is redundant foreskin and why it can cause kidney disease and other damage.
After puberty, the normal penis of a male is partially or completely exposed. If the foreskin covers all of the penis and urethral orifice, it can be turned upside down, indicating that the foreskin is too long. "If the opening of the foreskin is narrow or the foreskin adheres to the glans penis and cannot be turned upside down, it is considered phimosis.". Long phimosis and foreskin can easily cause foreskin scaling to accumulate under the skin. The foreskin scale is milky white with a fishy odor and consists of cortical gland secretions and epithelial desquamation. Accumulation of foreskin scale can easily lead to bacterial infection, causing penile foreskin inflammation. At the initial stage of the lesion, the penis and foreskin are red and swollen, hot, painful, and itchy, followed by erosion or the formation of ulcerated surfaces of varying sizes, and there are foul milky white purulent secretions. If the lesion continues to develop, the edema of the penis head will worsen, causing the foreskin of the penis to constrict, causing incarceration of the penis head, leading to blood and lymph circulation disorders in the foreskin and penis head, causing stasis, edema, and severe pain. If not treated promptly, ischemic necrosis can occur. Recurrent episodes of prepuceitis of the penis can cause adhesions of the prepuce and the penis, which cannot be turned up. In severe cases, it can lead to stricture of the external orifice of the urethra. "Some severe phimosis have a narrow opening like a pinhole in the foreskin, and when urinating, the foreskin bulges like a ball, causing poor urination.". Due to the stricture of the phimosis and urethral orifice, the bladder sphincter constricts during urination, and the internal pressure in the bladder exceeds the pressure that the bladder's Maori sheath can withstand before or at the same time overcoming the resistance of the urethral orifice. Urine reflux along the ureter, ureter, and renal pelvis dilation, causing bacterial infection in the upper urinary tract, scar formation, and leading to secondary reflux kidney disease and even renal function damage.
Patients with nephrotic syndrome are more prone to urinary tract infections due to long-term use of immunosuppressants such as hormones, low immune function, and long foreskin. Infection can cause recurrence or exacerbation of kidney disease. Therefore, if male nephrotic patients have urinary tract infections, it is important to understand whether they have long foreskin. The aforementioned nephrotic patient with an overlong foreskin had a urinary tract infection quickly controlled after removal of the overlong foreskin, and there was no recurrence for two years after the urinary protein turned negative.
Knowing the harm of excessive foreskin, circumcision should be performed as soon as possible.
