The difficulty or impossibility of opening the head of the penis at the bottom of the rubtsovih the changes and the narrowing of the foreskin, is called "the scar phimosis". The men of the pathology, it is usually secondary, or is the result of without treatment phimosis in childhood. The pathology they suffer from 2 – 3% of men. The scar phimosis brings many disadvantages to man: in addition to the inability of a normal hygiene standards, similar defect negatively influences the quality of sexual life, and run the cases of bankruptcy the act of urination.
In addition, due to the accumulation of smegma in the preputial bag and the reproduction of the bacteria, can develop the following diseases:
- the pyelonephritis.
Smegma – the product of the secretion of the glands, has carcinogenic properties, which can lead to cancer of the penis. Therefore, an adult man, even in a preventive way, it is necessary to get rid of the phimosis.
Lack of skills of the correct hygiene with children ages pre – equipped with a factor to the formation of adhesions of the head of the penis with the skin.
What is phimosis
Children small elongation and narrowing of the foreskin is of a physiological nature. As a general rule, as the growth of the penis, the head opens by itself. Some of the children, that is, occurs at 3 – 4 years, others 6 – 7, interventions rely more on my teenage years. With the exception of the expressed phimosis, which is an obstacle to the reflux of the urine and recurrent balanitis or balanoposthitis.
The adults often are diagnosed the scar phimosis. It produces the inflammation of the internal data sheet of the foreskin and the glans of the penis in the background of various diseases, including those that lead to sexually transmitted infections, the recurrent urogenital candidiasis, diabetes mellitus, genetically conditioned by the change of the connective tissue, burns and lesions in the genital organs, obesity. The cause is the decrease of the elasticity of the tissue and formation of adhesions (scarring).
What are the symptoms of the scar phimosis
There are a number of symptoms that the scar phimosis, according to which the urologist after physical inspection of diagnosis. The typical symptoms are:
- the inability to open the head;
- rubtsovie changes in the skin;
- the pain when you try to move the foreskin;
- the unpleasant sensations during the sexual contact, caused by the housing-filling of the cavernous bodies, the increase in the diameter of the member and the intensification of the oppression phimosis ring;
- appearance of discontinuities in the foreskin as a result of trauma and poor elasticity;
- painful nocturnal erection.
The adhesion secondary bacterial microflora appear purulent.
The scar phimosis in the male will not be resolved by itself, medical intervention is necessary in 100% of cases.
This condition develops when one tries to expose the glans penis with the application of effort, or after a sudden movement during the sexual act. The foreskin moves, but the neck of phimosis tightens the ring of the head of the penis, which leads to swelling and to the violation of the circulation of the blood in the body. Pain syndrome when paraphimosis expressed in a meaningful way, the head of the penis acquires a cyanotic hue.
The state is considered in urology urgent and requires immediate hospitalization with urgent operative treatment.
The delay causes fading in fabrics, in the most extreme cases, the amputation of the penis.
The stage of the scar phimosis
There are 4 stages:
1 stage: the head is naked in the "quiet" state, when the erection difficulties;
2 phase: difficulty is discovered the head in the erectus and resting, the pain.
Stage 3: the head does not open, the foreskin moves with great difficulty, with the emergence of sites of trauma when it disrupts the formation of adhesions, the selection of the drops of blood. The progression of the spaechnogo process leads to the next stage.
4 stage: the impossibility of withdrawing the head, the narrowing expressed phimosis rings, problems with the reflux of the urine, the padding of her preputial of the bag when the act of urination, change in the quality of the stream of urine.
What tests are needed for the scar phimosis
Lab tests includes the following tests, the same thing that you will need prior to hospitalization for the treatment of:
- the general analysis of blood and urine;
- the blood of syphilis, hepatitis b and c, hiv;
- >the sugar in the blood;
- study of sexually transmitted diseases for the establishment of a potential pathogen;
- blood group and rh factor;
- the definition of the clotting parameters of the blood (coagulation);
- a separate study of the urethra by microscopy;
- at the start of the secretions of deposit.the planting of the flora and sensitivity to antibiotics.
Survey instruments the scar phimosis informative and are run when you suspect inflammatory disease of the organs male genital.
If when you discover the head is to represent any growths, it is possible to take the biopsy, with subsequent histological study.
Sometimes, when you suspect an inguinal lymphadenitis is prescribed in the ultrasound of the regional lymph nodes.
The treatment the scar phimosis men
During the initial phases of the disease and the absence of pain possible the application of conservative therapy. It should be noted that, in the future, if you choose the resolution of the issue of these patients are going to be in the group of risk of recurrence of the disease. Because there is a tendency to adhesion, radical in the way of addressing the problem of a surgical intervention.
Medications for maintenance therapy:
- Corticosteroid ointment. Removed the process of inflammation, increases the elasticity of the skin of the foreskin, to relieve the swelling. In the framework of the application of hormonal ointments, artificially made to stretch the foreskin.
- Antibacterial drugs. Inhibit the growth and multiplication of the bacteria, possess a marked anti-inflammatory effect. When there is inflammation of broad-spectrum antibiotics that are assigned by the oral route in the interior, for the local treatment most appropriate medicines in the form of creams.
- The antiseptic solutions. Apply the bath or a lotion with the solution of potassium permanganate (permanganate), sodium bicarbonate (baking soda), with decoctions of plants that possess anti-inflammatory, wound healing properties: chamomile, calendula, sage, st. john's wort, oak bark.
In any case, before the operational planning of the treatment of a justification to cut the phenomenon of inflammation.
The surgical treatment of the scar phimosis
The laser therapy is applied in the early stages of the disease. In these cases, the application of laser, such as photo-degradation – efficient and least traumatic approach to the delicate problem.
The benefits carry the following:
- the rapid recovery of the patient after intervention;
- the possibility of keeping the foreskin and normal sensitivity of the glans of the penis;
- the absence of bleeding, the scar of the deformation;
- lowers the risk of adhesion of the infection;
- the integrity of the surrounding tissues;
- the possibility of performing the procedure on an outpatient basis.
The treatment with laser the scar phimosis is done under anesthesia and has a duration of 30 – 40 minutes. Outpatient phase involves the use of creams, anti-inflammatory, trays with antiseptic.
The classic radical of the methods of the release of the phimosis lead operation Circumcisio (circumcision).
Performed in hospitals or ambulatory surgical centers. The essence of the operation – the dissection and extraction (total or partial) in the foreskin, stitching cosmetics put self-absorbable thread. The recovery period is 3 – 4 weeks. If the operation was a success, and the postoperative period was treated without complications, sex after the circumcision, you can go a month approximately.
The main disadvantages lead to the increase of the sensitivity of bare head during sex, and, as a result, the ejaculation or the change of sensations during the sexual contact. As a general rule, these states do not require treatment.