In boys with only a nonretractable foreskin-due to foreskin adhesions-preoperative therapy should be attempted with an ointment containing corticosteroids (see “Further Therapy” below).
The following surgical procedures are available:
- Preputioplasty – foreskin plastic (foreskin-preserving).
- Circumcision (foreskin circumcision) – the foreskin can be removed completely (radical Z.) or partially (partial Z.)
In the case of a frenulum breve, i.e. a shortening of the foreskin frenulum (frenulum praeputii) between the inner foreskin of the penis and the front side of the penis, a frenulotomy can be performed. In this procedure, the foreskin frenulum is cut transversely and the subsequently existing mucosal defect is sutured longitudinally.
In infantile phimosis, circumcision is indicated between the age of two and school entry.
Note: In 10-35% of children, physiological phimosis is still present after the age of 3; approximately 1% of 16-18 year olds have pathological (pathological) phimosis.
Indications for circumcision:
Absolute indications (indications for use) [4, 5 ]
- Lichen sclerosus et atrophicus affecting the penis (therapy of choice).
- Scarred phimosis (e.g., after recurrent balanitis (glans inflammation), forced retraction attempts, trauma (e.g., entrapment in the zipper)).
- Paraphimosis
- Acute dysuria (difficult (painful) urination) in decompensated phimosis.
Relative indications
- Prophylaxis of urinary tract infections in cases of significantly increased risk of infection as a result of complex urinary tract malformations due to modification of the periurethral bacterial foreskin/glans colonization (dilating vesicoureteral reflux, posterior urethral valves, primary megaureter).
- Recurrent balanitis (inflammation of the glans) or balanoposthitis (inflammation of the glans and foreskin).
- Ballooning of the foreskin during urination as a result of obstruction of urination after inflammation or scarring (Note: in infants and young children partly physiological).
- Foreskin hypertrophic or constricted in intermittent catheterization (due toBladder emptying disorder, myelomenigocele).
- In the older child impossibility or pain in retraction of a too tight foreskin.
- Wish of the affected person / parents
In the case of phimosis (narrowing of the foreskin) that does not cause symptoms, definitive therapy can be waited until the end of puberty (= spontaneous solution of the foreskin).
For the procedure of circumcision see below “Circumcision”.
Paraphimosis is a urologic emergency and requires prompt intervention:
Acute therapy of paraphimosis
In the acute situation of paraphimosis, a physician should attempt to compress the tissue and then pull the constricted foreskin back over the glans penis (Latin glans “glans”). To do this, the glans is compressed firmly with one hand and the penis is compressed circularly with the other hand using the lacing ring. This pressure is applied for a few minutes. Then the glans is moved towards the base of the penis in the opposite direction to the foreskin. This procedure can be repeated if it did not work the first time. As a rule, paraphimosis can be resolved in this way.If the reduction remains unsuccessful, a dorsal incision can be made.Only when the accompanying edema has subsided should surgical therapy (circumcision) be performed.
