Surgery indicated for phimosis pathological forms of reduction of the foreskin, when the exposure of the glans impossible, too painful, violates the sexual life, often causes inflammatory processes. The most common treatment can be considered to be the circumcision, which today is carried out not only in the traditional way, known since antiquity, but with the help of modern technology and laser surgery.
Phimosis is pathological when the foreskin is not able to move to a full exemption from the skin of the glans of the penis. As a physiological phenomenon, it is typical for the neonatal period and childhood, and becomes pathological in adults, men and young people, after puberty, including in the background of scar and changes the inflammatory.
Surgical treatment when the disease, phimosis is the only drastic measure to get rid of the disease. According to statistics, approximately a quarter of adult men have undergone circumcision for this reason. In this disease there are several types of operations, the choice of which is determined by the age period, the type and severity of the disease, medical training and equipment operating.
In our day-to-day practice:
The treatment can take place traditionally, that is to say, by means of a scalpel, a modern form of laser. Traditional therapy is available, relatively cheap and can be done in any hospital where a urologist, but it has limitations:
The indication of surgical treatment is considered to be pathological phimosis in children and adults, men, and all of the complicated forms of the disease in patients of any age, and relapses inflammation of the foreskin and the glans of the penis condylomatous, foreign objects under the foreskin.
Among the obstacles:
Before planning the surgical treatment of phimosis child or adult will be assigned a list of tests — tests of blood, urine, ECG, chest x-rays, a study for infection, etc. depending on your age. This can be carried out in the place of residence to the clinic. Mandatory detention therapist or pediatrician about the absence of common contraindications. When planning General anesthesia, the patient consultation with the other, and the anaesthetist that revealed the presence of allergies, experience with anesthesia in the past, the names of the medicines.
2 weeks prior to the treatment of cancel funds that make the blood more liquid. The house in the morning of the intervention the need to wash carefully the genitals with warm water and gentle soap, in adult men, the hair from the pubic area and groin are removed independently at home, avoiding breaks in the skin, or in the hospital, parents take children to the clinic for diapers, wipes and other necessary baby toiletries. If the planned intervention under General anesthesia for 8 hours before and the morning immediately before the surgery you can not eat or drink.
After the admission, which must sign the relevant documentation, sign a written consent (the patient or the parents of the child), to talk again with the urologist and anesthesiologist, which may take 2-3 hours, so it is better to get there in advance. Work patients-men must release this day of work, because even if quickly carried out the procedure, and immediately "run" the operation is unlikely to succeed.
Adult men are informed that after the withdrawal of the phimosis will not be able to drive not only due to the surgical trauma, but even in a greater extent because of the introduction of sedatives or drugs for anesthesia. In this sense, we must take into account to move forward as you will get home.
During the procedure, the patient lies on the back, with the legs separated. The surgeon proceeds to the manipulation after the onset of full anaesthesia. In the case of a local anaesthetic gel, is applied in advance, and in the blocking of the nerve roots at first limited to the exploitation of the field, the skin is treated with antiseptic, and then in a nerve injected with anaesthetics.
Regardless of the technique chosen for removal of the phimosis, the operation area is treated with iodine, and the surgeon is not limited to penis — treatment is necessary and the stomach, and the skin of the scrotum and thighs. After this, the patient harboring sterile clothing, leaving not only closed the place that will host manipulation.
To enlarge the small openings of the foreskin, the surgeon has clips. After that take the skin back to the exhibition with the head, in the presence of adhesions — that should be separated. If you plan on circumcision after these actions the expert contours of the line, which will continue to operate with a scalpel.
One of the oldest and most widespread interventions, which is used for the treatment and prevention of phimosis, and religious reasons, is the circumcision. Developed many production techniques, but the choice always remains with the surgeon, who evaluates the clinical situation and the technical possibilities of treatment.
The type of circumcision:
The indications for the use of the dorsal slit are phimosis and paraphimosis. The advantages of this surgery are the possibility of carrying out alone without a second surgery and low risk of complications, but there is a serious drawback: the surgeon must be experienced and have the appropriate skills for this type of operation.
The dorsal slit technique involves several steps:
During the manipulation of the vessels are combined and then laid on the wound sterile dressing is applied.
Application of clip is considered a technically simple method of operation, does not require the presence of a second surgeon, however, the disadvantage of that it is considered probable satisfactory aesthetic result some time after the intervention.
In the application of the clamp, the surgeon will first grab the skin with clips, pull it to the desired cutting length. In direct continuation of fixed-grip the foreskin and cuts it near the head of the penis. After the cut, the skin becomes and secured with sutures. In the conclusion of a careful hemostasis sterile bandage.
Circular resection technique is very precise, but it requires a good command of the surgeon, their characteristics, and the presence of a wizard. It is used in the development of the subcutaneous veins, as it provides a lower risk of bleeding.
With circular resection of the first, the surgeon marks incision lines on the edge of the head and at the point of union of the prepuce, then makes a long incision along these lines skin flap, separating it from the penis. After the removal of the skin sutures, uniting the blood vessels, the wound is covered with a cloth sterile.
Newborns and babies first years of life, surgeons strive to apply the non-traumatic varieties with the use of tweezers special.
The clip is a plastic single use, that looks like a bell. This technique is very attractive, since it does not need stitches. During the surgery, the urologist makes an incision vertically from the free edge of the skin in the direction of the root of the penis, on mental 12 hours, then the head puts a clip that is covered with leather, fixed by thread. The excess foreskin is cut off, and the handle "bell" is. After about a week, the ring of plastic itself disappears.
The clips are designed for multiple applications, but its use in the form pathological of the disease is very limited. Today the specialists-urologists resort to them less often. The kids when using these clips, the seams do not overlap, and adults, in view of the possible erection necessary the edges of the wound to close.
Circumcision alternative method of surgical treatment of phimosis is considered praeputium, which is limited to cases in which cicatricial changes touched only the tip of the foreskin. This operation for phimosis outpatient basis, takes about 20 minutes and gives less consequences and less pronounced pain.
A contraindication for plastic surgery of the prepuce may become excessive contraction and fibrosis, when this operation can cause a relapse of the disease.
Technical praeputium includes a series of sequential steps:
Meatoplasty is a method of correction, surgical narrowing of the orifice of the urethra. It serves as a complement to other procedures, if the phimosis is a narrowing of the urethra in its final part. This happens in cases of severe phimosis as a result of clear balanite.
When Meatoplasty surgeon produces the cystoscope to examine the urethra endoscopically to remove the stenosis in other areas. If found, the patient may need surgery to enlarge the urethra – stenting.
In recent years, medicine widely used laser, and urology is no exception. Laser technology, elimination of phimosis implies the use of a laser instead of a scalpel and scissors. The luminous Flux that caused the warming of the tissue, the evaporation of water and the destruction of the cells, acting as a cutting tool. The technique of the operation is similar to that in the circumcision.
Laser circumcision has a number of important benefits:
Experts say that laser treatment prevents the lesion of vessels with heavy bleeding as the light beam heats up and seals your walls, so this method is selected in the pathology of clotting in a patient or a high risk of bleeding. By the way, that began to be applied in Israel for the treatment of a child with hemophilia.
Disadvantages of laser treatment is considered to be low availability due to the high cost of the equipment, which may allow a single clinic, the need for specialists who know the technique of laser treatment of phimosis, as well as the high cost of the operation for patients.
When the operation is over, the operated transportyou to the recovery room stay, where he spends a few hours in the absence of any complaint or signs of complications. If all goes well, it will go home the same day. Otherwise, the hospital will have to stay.
Operative treatment of phimosis is not considered to be traumatic and not to restrict the activity of patients, but the experts-urologists still recommend the first few days lying in bed: lying reduces the inflammation of the genital organs. For the fixation of the penis you will need to wear tight clothing.
Regardless of the technique chosen, each type of operation involves the use of a bandage (bandage). He needs to be in the first several days to protect the penis of the earth, and also to avoid the strong inflammation. A bandage is applied so that the opening of the urethra was not closed and equipped with urination.
A few days later, the bandage can be removed by a doctor or by the patient (parents). If he did have time to dry and adhere to the skin, should be wet with antiseptic (chlorhexidine, for example), and only then, carefully separate. Neglected and forced the removal of dressings can cause damage to the mucous membranes of the body, and complications.
The bandage is removed after a few days. The penis will be swollen and somewhat enlarged, that should not cause fear. The swelling can last a week, but then gradually go away. Surgeons often use wires that do not have to be removed, as it resolve itself, but if it is not resolved after the 10th day of the recovery period, must be removed in the doctor.
Regular stitches after surgery removed at the end of the first week or a bit later. Best if you remove them, the surgeon who carried out the intervention. Still controls the process of regeneration.
The effect of the treatment can be evaluated not at the same time, because you need to restore a quite a long time — sometimes up to six months. At this time, the possible complications — abscess, hemorrhage with bruising, pain during erection, severe scarring along the seam.