Introduction
Phimosis (synonym: foreskin tightness) is caused by a disproportion between the width of the foreskin and the size of the glans penis (glans penis). Due to this narrowness, the foreskin cannot be pulled back behind the glans penis from about the age of 2 years. This can lead to inflammation, pain and complications when urinating. In addition, too tight a foreskin can lead to the emergency situation of paraphimosis. In this case, the foreskin can no longer be pulled forward and thus prevents the blood supply to the glans.
Etiology
The prevalence is 5-7% for boys between 5 and 7 years. At the age of 16 years about 1% of the boys are still affected.
Symptoms
Symptoms of phimosis may include pain when urinating or ballooning of the foreskin (balangitide) when urinating. The urine cannot be emptied completely, but flows behind the foreskin and makes it swell. In addition, genital hygiene cannot be carried out thoroughly enough, which can lead to inflammation of the glans or foreskin. These are accompanied by pain, swelling of the glans and reddening and are usually very annoying for the person concerned. It is not uncommon for the glans to turn a bluish color during an erection.
Diagnosis
Phimosis is usually noticed at home by the mother or by the boy himself, depending on the extent of the foreskin tightness and the symptoms. Therefore, no diagnostic equipment is necessary to diagnose phimosis with certainty. The tactile and visual findings in combination with the symptoms described are usually sufficient.
The only curative therapy is surgical circumcision (circumcision). Under no circumstances should manual retraction be performed. This can not only have traumatic consequences for the child, but is also painful and can lead to injuries of the foreskin.
These in turn can scar and thus lead to scarring phimosis. Thus, all foreskin constrictions are corrected surgically. The foreskin can be removed only partially or radically, as the parents wish.
Circumcision is nowadays a routine procedure and can be performed on an outpatient basis if the procedure goes without complications. The operation is usually performed between the 2nd year of life and school entry, provided there are no problems, pain or complications. If this is the case, the operation should be performed as soon as possible, regardless of age. Contraindications for surgery are infections or other genital abnormalities. Especially hypospadias (anterior cleft formation of the urethra) is a contraindication, because for this surgical correction the foreskin is preferably used to completely close the urethra.
