Tight foreskin or phimosis is a condition in which there is considerable difficulty in retracting the foreskin. This is a fairly common occurrence among infants and toddlers. The main form of management for many years has been circumcision but that has been changing in recent times. There are many alternatives that can be used today. We will explore how one can relieve tight foreskin without circumcision in this article.
Before deciding on the kind of intervention to be undertaken, a proper diagnosis will be made. It worth noting that close to 96% of male infants have some degree of nonretractability of the foreskin at birth. This is due to the presence of adhesions between the foreskin and the glans penis. This condition is known as physiological phimosis as opposed pathological phimosis that occurs due to conditions such as infections, trauma and hormonal influences among others.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
Conservative surgery is yet another option that can be considered. It is different from traditional circumcision in that not the entire foreskin is removed. Prepu-tioplasty is one of such procedures and simply involves making a small incision on the skin without removing it. Other similar procedures include frenulotomy and meatoplasty. The advantages of these procedures is that they are less costly, have faster recovery and are associated with less pain.
Dilatation and stretching is one of the most commonly performed alternatives. It can be carried out with ease in an outpatient department. Not only is it cheap and easy to perform but is also quite effective. All that is required is the application of a local anaesthetic agent into the foreskin. The main disadvantage is that it will not work well in the presence of infections of the foreskin.
Conservative surgery also has its place. This is a procedure in which only part of the skin is incised while the rest is left intact. An example is prepu-tioplasty which involves the creation of a small incision on the upper part. Others include frenulotomy and meatoplasty. The main benefits include, quicker recover, less cost and simplicity. The downside is that phimosis may recur.
Topical Steroids have been used in the management for this condition with success rates ranging from 65 to 95%. The exact mechanism involved in how these steroids work is not well known. However, some of the theories are that it has local anti-inflammatory actions. It is thought that they result in the production of a substance known as lipocortin which mediates the anti-inflammatory and anti immunity actions. The advantage is that steroids may lead to thinning of skin.
Circumcision is an important procedure as relates to the management of phimosis. It has been the first line mode of intervention for many years but this has been changing in recent times. Some of the contributing factors are the cost, associated risks and complexity. Several alternatives now exist. Parents should be educated on these alternatives and allowed to make decisions based on the merits and demerits of each.
Before deciding on the kind of intervention to be undertaken, a proper diagnosis will be made. It worth noting that close to 96% of male infants have some degree of nonretractability of the foreskin at birth. This is due to the presence of adhesions between the foreskin and the glans penis. This condition is known as physiological phimosis as opposed pathological phimosis that occurs due to conditions such as infections, trauma and hormonal influences among others.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
Conservative surgery is yet another option that can be considered. It is different from traditional circumcision in that not the entire foreskin is removed. Prepu-tioplasty is one of such procedures and simply involves making a small incision on the skin without removing it. Other similar procedures include frenulotomy and meatoplasty. The advantages of these procedures is that they are less costly, have faster recovery and are associated with less pain.
Dilatation and stretching is one of the most commonly performed alternatives. It can be carried out with ease in an outpatient department. Not only is it cheap and easy to perform but is also quite effective. All that is required is the application of a local anaesthetic agent into the foreskin. The main disadvantage is that it will not work well in the presence of infections of the foreskin.
Conservative surgery also has its place. This is a procedure in which only part of the skin is incised while the rest is left intact. An example is prepu-tioplasty which involves the creation of a small incision on the upper part. Others include frenulotomy and meatoplasty. The main benefits include, quicker recover, less cost and simplicity. The downside is that phimosis may recur.
Topical Steroids have been used in the management for this condition with success rates ranging from 65 to 95%. The exact mechanism involved in how these steroids work is not well known. However, some of the theories are that it has local anti-inflammatory actions. It is thought that they result in the production of a substance known as lipocortin which mediates the anti-inflammatory and anti immunity actions. The advantage is that steroids may lead to thinning of skin.
Circumcision is an important procedure as relates to the management of phimosis. It has been the first line mode of intervention for many years but this has been changing in recent times. Some of the contributing factors are the cost, associated risks and complexity. Several alternatives now exist. Parents should be educated on these alternatives and allowed to make decisions based on the merits and demerits of each.
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