The operation of phimosis is displayed when pathological forms narrowing of the foreskin, when the outcrop of the head of the penis is impossible, it is too painful, violates the sexual life, causes frequent inflammatory processes. The most common method of treatment can be considered the circumcision, that in our days not only in the traditional way, known since antiquity, but with the help of the modern technologies of laser surgery.
Phimosis is a condition when the foreskin is not able to move to the complete liberation of the skin from the head of the penis. As physiological, and is characterized in the neonatal period and early childhood, and becomes pathological in adults and adolescents after puberty, including — in the background rubtsovih the and inflammatory changes.
The variety of interventions and methods of pain relief
The surgical treatment of the disease, phimosis is the only drastic measure of the release of the pathology. According to statistics, about one-fourth of the adult males suffered circumcision is precisely for this reason. When this disease are possible several types of operations, the selection of which determines the age of a period, the type and severity of the pathology of the qualification of the doctor and operating team.
In our days, the practice:
- The circumcision;
The treatment can be performed traditionally, that is to say, with the use of a scalpel, or a modern form — laser. The traditional treatment is available, relatively cheap and can be performed in any hospital where there is a urologist, but that is not without drawbacks:
- The recovery of long-lived due to the higher trauma;
- A higher risk of complications.
- The need for the duration of the restriction of the sexual life;
- The risk of formation of scars in the place of the suture.
Indications and contraindications to the surgery
The indication for surgical treatment is considered pathologic phimosis in children and adults, men, all the complicated forms of the disease in patients of any age, as well as relapses of inflammatory defeat is very of the flesh and of the head of the penis condylomatous, foreign objects under the foreskin.
Among the obstacles:
- Heavy decompensated pathology of the internal organs until the time of stabilization of the current of the disease;
- Acute infections;
- Pathology of hemostasis;
- Colitis-the defeat of skin in the area of the foreskin (temporary contraindication);
- The structural changes of the penis (hypo - and epispadia) - required plastic;
- The infection of the urinary tract and genitals (acute or recurrence of the chronic) — until the healing of the same.
Preparation for surgery
Before planning operative treatment of phimosis on a child or an adult is assigned a list of the necessary studies — the analysis of blood, urine, electrocardiogram, x-ray of the organs in the chest, the research of the infection, etc, depending on the age. Can pass by their place of residence in the health center. Mandatory celebration of a therapist or a pediatrician about the absence of general contraindications. When the planning of the general anesthesia of the patient advisory and anesthesiologist, to find out the presence of allergies, the experience of the anesthesia in the past, the name of medicines.
2 weeks before the treatment is cancelled with the tools that make the blood more liquid. The house in the morning on the day of the intervention it is necessary to carefully wash the genitals with warm water with a mild soap that of the adult males pubic hair of the groin area and is eliminated in your house, avoiding cuts to the skin, or in the hospital, the parents of the children are taken in the clinic for diapers, wipes and other necessary baby hygiene. If the surgery is planned under general anesthesia for 8 hours before him and, from the morning, just before the surgery can not eat and drink.
After admission to the hospital shall submit the documents, sign the written consent (the patient or the parents of the boy), to speak again with the urologist and the anesthesiologist, which can take 2 to 3 hours, so you get better advance. Working patients-the men must release this day of work, since even in the case quickly carried out the procedure immediately "run" in the work of a few chance of success.
The adult male reported that after the removal of the phimosis will not be able to get behind the wheel, not only by the operating of the injury, but even to a greater extent, due to the introduced sedatives or drugs for anesthesia. In this sense, it is necessary beforehand to consider how you can get home.
The technique of operations
At the time of the procedure, the patient is in the supine position with the calf of the feet. The surgeon proceeds to the handling after the arrival of the complete anesthesia. In the case of the local anesthetic gel is applied with sufficient advance notice, and to the blockage of the nerve root is first limited to the operative field, the skin is processed antiseptic, and then in the nerve is introduced anesthesia medication.
Regardless of the technique of removal of the phimosis, the area of operation is processed with iodine, and the surgeon is not limited to the penis — processing needed, and in the stomach and the skin of the scrotum and the thighs. After this patient full of clothes sterile, not leaving closed only the place where will take place of the handling.
To expand reduced orifice of the prepuce surgeon takes forceps. After this, remove the skin backward to the exposure of the head of the authority, when there are adhesions should be divided. If you are going to the circumcision, after these steps, the specialist points to a line of continue with a scalpel.
One of the oldest and most common interventions, that is applied for the treatment and prevention of phimosis, and, for religious reasons, is the circumcision. Developed many techniques of his realization, but the choice is always the surgeon, who evaluates the situation and of the technical possibilities of treatment.
Types of circumcision:
- The method of dorsal incision;
- The operation with the use of the clamp;
- Circular resection.
Indication for the application of cord cutting are considered phimosis and paraphimosis. Advantages of this operation are the possibility of perform only, without a second of a surgeon and a low risk of complications, however, there is a serious drawback: the surgeon must have experience and have the ability to perform this type of operation.
The technique of cord cutting includes several steps:
- The overlap clips in the foreskin;
- The dissection of the skin in the legend of 12 hours;
- The cut of the skin in the marked line, the suture.
During the manipulation combine the vessels, after the wound is placed sterile dressing.
The use of the caliper is considered to be simple, technically, the form of the operation, does not require the presence of a second surgeon, however, the disadvantage is that it is considered likely unsatisfactory aesthetic result some time after the intervention.
When you apply the forceps surgeon first catch the skin of terminals, by pulling the cutting length. Then direct clamp-secures the foreskin and cuts its closer to the head of the penis. After trimming the skin removed and fixed with stitches. At the completion of a careful hemostasis is placed a sterile bandage.
The technique of resection circular very accurate, however, presupposes the knowledge of a surgeon, their characteristics, and the presence of an assistant. It is applied in developed countries, the veins under the skin, since it gives a lower risk of bleeding.
Circular resection of one surgeon first marks the lines of incision on the edge of the head and the site of insertion of the foreskin, and then makes an incision of these lines of the skin flap, which separates it from the penis. After excision of the skin overlap the seams, combine the vessels, the wound is covered with a cloth sterile.
In newborns and children in the early years of the life of surgeons to try to apply not traumtico special varieties of clamps.
The clip is an accessory of plastic single-use, which resembles a bell. This technique is attractive because it is not necessary to put points. During the procedure the urologist makes a vertical incision is made from the free edge of the skin in the direction of the root of the penis mental 12 hours and, then, to the head of the put the clip, which escapes to the skin, fixed in the thread. The excess foreskin is cut off, and the handle of the "bell" separates. After about a week the plastic ring itself, disappears.
The clamps are designed for repeated use, however, the possibility of its use in the pathological of the disease are very limited. Today's specialists in the field of urology have been using them ever less. The children in the application of these clamps on the seams do not overlap, and adults, due to a possible erection should wound edges to cook.
Alternatives to circumcision in the method of surgical treatment for phimosis is considered praeputium, which is limited to cases in which the scar change has touched only the tip of the foreskin. This operation of phimosis is performed on an outpatient basis, it takes about 20 minutes and gives a lower number of effects and less expressed pain.
Contraindications to the use of plastic, the foreskin may be excessive narrowing and fibrosis, when this operation may trigger a relapse of the pathology.
The technique of praeputium includes a series of successive stages:
- the realization of a small longitudinal incision of the foreskin in the direction of the root of the penis, while the value of court must ensure the freedom of outcrop of the head of the skin to its backward movement;
- in the case of the scar phimosis surgeon in parallel with the cut of the skin, breaks up the fibrotic adhesions;
- the imposition of the seam of the skin, which provides the outcrop of the head of the authority.
Meatoplasty is a method of surgical correction of the narrowing of the exit of the urethra. It serves as a complement to other procedures, if the phimosis given the narrowing of the urethra at the end of the. This happens when severe phimosis as a result of obliterans balanite.
When Meatoplasty the surgeon performs a cystoscopy to explore endoscopically the urethra and remove the stricture in other sites. In case of being discovered, the patient will need an operation of enlargement of the urethra – the placement of stents.
The treatment of phimosis laser
In recent years, in medicine it is widely applied to the laser, and urology — is no exception. Laser technology removal of phimosis involves the use of a laser instead of a scalpel and scissors. Flow of light, which causes tissue heating, the evaporation of water and the destruction of the cells, acting as a court instrument. The technique of the operation is similar to that of such, during the normal use of the circumcision.
Laser circumcision has a number of important advantages:
- Gives a lower number of complications (infection, bleeding);
- The pain after the surgery, said the child;
- Has a high precision.
- Shorter recovery period (3-4 days against two weeks of the operation);
- The shorter duration of the operation itself (up to half an hour).
The specialists claim that laser treatment prevents lesions of the vessel with a strong hemorrhage, as well as the beam heats up and seals your walls, so this technique is selected in the pathology of clotting of the blood in the patient, or high risk of bleeding. To the word, for the first time applied in israel for the treatment of the child with hemophilia.
Disadvantages of the laser treatment is considered to be of low availability due to the high cost of the equipment, which can afford the luxury of a single unit of the clinic, the need for professionals who possess the technique of laser treatment of the phimosis, as well as the high cost of operation for the patients themselves.
After the operation
When the operation is finished, treatment transported in the camera of postoperative stay, where you spend a few hours in the case of the absence of complaints or signs of complications. If all goes well, I'll be home the same day. In the opposite case, in the hospital, have to stay.
Treatment for phimosis is considered non-traumatic and that it does not limit the activity of the patients, however, specialists in the field of urology all advise over the first few days of being in bed: lying down decreases the inflammation of the genital organs. For the fixing of the penis will have to get a bed linen.
Regardless of the technique selected, each type of operation involves the use of a dressing (bandage). You need to be in the early days for the protection of his penis against pollution, as well as for prevention of a strong swelling. The bandage is applied so that the opening of the urethra was not private, and that it ensures the evacuation of the urine.
A few days later, the dressing can be removed by the doctor or by the patient (parents). If you've got dry and stick to the skin, should be wet antiseptic (chlorhexidine, for example) and only after clearly separate. Reckless and force the removal dressing material can cause damage to the mucosa of the authority and of the complications.
The bandage is removed after several days. The penis is oedematous, several of prolonged duration, that should not cause a scare. The swelling can last for a week, but then little by little they will be. Typically, surgeons use the thread, that it is not necessary to remove, as they resolve themselves, however, if they are not resolved after 10 days recovery period, it is necessary to eliminate the doctor.
Normal the seams after the operation is done at the end of the first week or a little later. Better, if they are removed the surgeon, in his intervention. When this still and control the regeneration process.
The effect of the treatment can be seen not immediately, as in the restoration needed a lot of time — sometimes up to six months. At this time, there can be complications, resentment, bleeding with hematoma formation, pain during erection, the strong healing of the seam.