Categories: Paediatric Surgery

Phimosis and Para-phimosis

What is Phimosis?

The condition, phimosis is the inability to retract the foreskin (prepuce). The foreskin covers the head (glans) of the penis. Phimosis can be physiological and pathological. The present incidence of phimosis is about 1-2%.

The phimosis is known as physiological when the newborn child has tight foreskin adherent to the glans penis. Its natural separation occurs over the first 2-3 years of life. It is normal to have phimosis in a young child.

The phimosis is known as pathological when it is associated with infection, ballooning of preputial skin while passing urine, and if it remains beyond the age of 4 years. Each attack of balanoposthitis leads to scarring of the foreskin and worsen the condition further. Even forceful retraction of the foreskin can lead to bleeding, increased scarring, and it is traumatic to the child and parent. Pathologic phimosis needs to be evaluated by the Pediatric Surgeon for further management.

How to take care of a child who is not circumcised?

Generally, it does not need any special care. The forceful retraction of the foreskin should be avoided. One can do gentle retraction of the foreskin though it is not necessary. The forcible retraction can lead to tearing of the preputial skin with bleeding. The tear will heal with fibrosis and lead to phimosis.

What is Paraphimosis?

The retracted foreskin of the penis should be pushed back to normal position. If it remains in the retracted position then the patient can develop the condition which is known as Paraphimosis, which is a surgical emergency. In paraphimosis, the retracted skin forms a constricting ring with oedema of the glans penis and the foreskin. It can be reduced manually and if a manual reduction is not possible then the child should be taken to the operating room and manual reduction should be performed under general anaesthesia. These patients should undergo circumcision to prevent the recurrence of paraphimosis.

What is Smegma?

It is the collection of shredded skin cells from the glans penis and inner foreskin. This process helps to separate the foreskin from the head of the penis. It appears as the white pearls underneath the skin, which can easily be washed off once the foreskin is retracted.

How do the Phimosis patients present to the Pediatric Surgeons?

The pathologic phimosis presents with itching of the foreskin and/or bleeding, ballooning of the foreskin while passing urine, rarely urinary retention, painful urination (dysuria), painful erections, recurrent infections of the foreskin (balanoposthitis), paraphimosis, or urinary tract infections.

How is the Phimosis treated?

If the foreskin is supple then the local corticosteroid ointment application can be tried for 3-4 weeks. It is advocated not to continue local steroid ointment beyond 3-4 weeks as it can give rise to complications related to the use of steroids. Those who don’t respond to local steroid ointment or whose foreskin is fibrozed should have circumcision done.

Circumcision:

In boys, circumcision means the surgical removal of the foreskin. In children, it is performed under general anaesthesia. It can be done as a daycare procedure. Post-surgery, they need paracetamol or other medicines to control the pain and local ointment to decrease the sensation of glans and infection. After a few days of circumcision, the parents are advised to make the child seat in warm water to keep the area cleaned.

Dr. Rasik Shah | Senior Consultant – Paediatric Surgery | NH SRCC Children’s Hospital, Mumbai

Narayana Health

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