Phimosis in children

Should you be upset if your doctor diagnoses your child with phimosis? Phimosis in children is a painful opening or inability to open the head of the penis due to narrowing of the preputial opening. Almost all infants of infant age have inelastic foreskin, but with age this physiological state normalizes, and the problem disappears. The norm - if the head begins to open well by school age, but sometimes this period is prolonged until the beginning of sexual development, which is also not considered pathology. But pain, urinary disorders - this is already a cause for concern and a visit to the doctor. [1]

Epidemiology

Only in 4% of cases, boys are born with an already formed ability to expose the head of the penis. Thus, in 96% we should talk about physiological phimosis, which passes independently at different ages: more often it happens already in 3-4 years, less often - in 6-7 years. But even in schoolchildren such asymptomatic phimosis is not considered a problem, as in the vast majority of cases it disappears with the onset of puberty.

The head of the male penis is covered by a specific mobile skin sheet, or more precisely, two sheets of foreskin: the outer and the inner. A normal adult male can easily remove this skin and expose the glans. In the space between the glans and the inner sheet is a cavity where a glandular secretion called smegma is produced. This secretion is intended to facilitate movement of the foreskin and to protect the glans from unnecessary irritation.

All male newborns have a foreskin that is completely covered by the head of the penis. This is the norm, which in medical circles is called physiological, or natural, natural form of phimosis. Moreover, on the inner side, the skin sheet may be glued to the glans with special thin soft adhesions - synechiae, which is also considered normal and does not require any intervention.

Gradual separation of physiologic adhesions most often occurs during the period of 3-5 years, but can extend to 8-9 years, and even up to 12 years, which is not considered a pathology. In almost all boys (with a few exceptions), complete exposure of the head becomes possible before the onset of sexual development (approximately 12 years of age). Whether it happens earlier or later depends on the individual characteristics of the child. [2]

Causes of the phimosis in children

Pediatric urologists most often encounter congenital phimosis. This disorder is said to occur if the physiological constriction does not disappear on its own, either in early childhood or at the onset of puberty.

About the reasons for the appearance of such a problem, experts cannot say for sure. However, scientists have noticed that in some families phimosis is diagnosed more often, which suggests the existence of a hereditary predisposition to pathology.

According to clinical studies, the congenital form of the disorder often coexists with other disorders of the connective tissue structures and musculoskeletal system - in particular, spinal curvatures, cardiac malformations, flat feet, and so on.

In childhood, traumatic injuries to the genitals can also be the cause - for example, if parents or incompetent doctors made aggressive attempts to "cure" the physiological type of phimosis in children. In such situations, adhesions form in the damaged area, causing narrowing of the prepuce space and the formation of secondary - already pathological - phimosis.

In addition to the above, there is often another cause. It is about infectious-inflammatory reactions in the area of the foreskin, which provoke the formation of a typical scar phimosis.

Risk factors

Predisposing factors to the development of phimosis may include:

• unfavorable heredity, when lack of connective tissue is the cause of low elasticity and poor extensibility of the prepuce;
• diabetes;
• failure to observe intimate hygiene, or overzealous observance of it;
• traumatic injuries to the genitals;
• metabolic disorders, obesity;
• severe emotional, physical stress.

Pathogenesis

Phimosis is said to be a narrowing of the foreskin (from the Greek word phimosis , tightness, closure, compression), when it becomes impossible to expose the glans region of the penis, or it is exposed with the formation of a tightening contour (stretching). Phimosis can be considered both normal and abnormal, depending on the age of the child and the symptoms present.

The fetal penis begins to form in the seventh week of gestation. By week 24, this organ is already fully formed. The foreskin is formed from a small rudiment of skin.

The penis has three parts: the body, the glans and the root. In the cephalic region there is an urethral outlet, which in medicine is called the meatus. The area itself is covered with sheets of skin - this is the foreskin, or prepuce, which is easily displaced in adulthood. The inner layer of the prepuce is thinner and more delicate, similar to mucous tissue. Before the baby is born, this layer is fused to the head by layers of epithelium called synechiae. In some babies synechiae disappear not after birth, but a little later, which is not a violation. Gradually, in the course of growth of the childbearing organ, the preputial sheets are pulled apart, the natural adhesions are independently separated, and the head is exposed. This course of events can continue for a long time, until the start of puberty of the future man. It is at this time that the production of sex hormones is stimulated, which directly improve the elasticity and extensibility of the prepuce tissue. [3]

A positive outcome with self-correction of phimosis is possible not only in physiological disorders, but also in some pathological conditions, such as hypertrophic phimosis. Such phimosis usually disappears at a very late stage or does not disappear at all, which requires the assistance of a surgeon. [4]

Symptoms of the phimosis in children

Phimosis can be easily detected by visual inspection: first of all, it is not possible to fully expose the head of the penis because of the narrowed preputial opening. In scar phimosis, the prepuce is elongated and narrowed, resembling a proboscis.

If all the necessary sanitary and hygienic rules are observed and there are no inflammatory diseases, phimosis does not cause any physical discomfort to the child. In adolescence, there may be discomfort at the time of erection.

Difficulty during urination, redness of the skin of the genitals, the appearance of pain, all these are the first signs of complications and a reason to urgently visit a doctor.

What phimosis looks like in a child

The clinical picture in phimosis differs, depending on the degree of violation.

• The 1st degree of phimosis in a child is considered a minor disorder, in which there is no pain and the head of the penis, which is in a calm state, is effortlessly exposed. However, in the state of erection, a small effort will still have to be made. Such phimosis in children, as a rule, does not require treatment: a wait-and-see approach is used.
• Phimosis 2 degree in a child is considered a moderate violation, sometimes it is called "incomplete phimosis": exposure of the head at rest of the penis requires little effort, but in the state of erection attempts to expose causes painful sensations.
• The 3rd degree of phimosis in a child is characterized by the possibility of partial exposure of the head when the penis is at rest. In the erect state it is not possible to do this. The third degree is often combined with excessive subpreputial accumulation of smegma, frequent inflammatory processes. Urinary function is not affected.
• Phimosis of the 4th degree in a child is already a severe pathology, in which there is no possibility of opening the head even in the state of a quiet penis. Frequent inflammatory processes are noted, stagnant phenomena are detected. During urinary excretion, the prepuce inflates, filling with urine. Urine excretion is difficult (the stream is thin or dripping). The patient feels physical and mental discomfort, which requires urgent intervention by a doctor.

Psychosomatics of phimosis in a child

The task of psychosomatics is to discover the event or situation that activated the development of phimosis and allowed the problem to integrate into the patient's consciousness. It is known that every problem and every disease has its root, its root cause. Only by discovering and eliminating this source, it is possible to get rid of any pathology, including phimosis. What can these sources be? [5]

• Constant stress, severe emotional distress (conflicts in the family and at school, lack of time, severe physical exhaustion, etc.).
• Prolonged experience of powerful negative emotions (fears, resentment, anger, frustration).
• Unexpressed emotions (suppression of feelings and experiences).

A child is often a kind of "mirror" of the whole family. It demonstrates all the complexities and nuances of family relationships. If there are problems with children's health in the family, it is a psychosomatic sign that everything is not in order.

Stages

Depending on the ability to stretch the sheets of the foreskin and the quality of the opening of the head of the penis, distinguish the stages of phimosis:

1. It takes a little effort to release the glans only during an erection, and in the normal state the opening is normal.
2. Little effort is required to open the head in its normal state.
3. The opening is difficult, but no urinary disturbances are detected.
4. Opening is impossible, there are problems with urine output.

It is important to note that the diagnosis of stages I-III of the pathology can be carried out only in adult men or adolescent patients. Regarding stage IV, it is necessary to say the following: in normal physiologic phimosis, urinary excretion should be free. If the preputial sac is filled during urine excretion, or the liquid flows in a narrow trickle, it can be regarded as a pathology that requires medical attention, regardless of the age of the child.

Forms

About the pathological variant of phimosis can be said not earlier than from 7 years of age, and sometimes - and even later. The disease is divided into several types: of these, scar phimosis in a child is more common, and less common are atrophic and hypertrophic.

Hypertrophic phimosis in a child is manifested by elongation and narrowing of the prepuce, which looks like a trunk, so this type of phimosis is often called "trunk". Pathology is difficult to give conservative treatment, and all kinds of stretching procedures in most cases are unsuccessful. Trunk phimosis in a child is mainly treated surgically. [6]

The atrophic form is very rare. It is diagnosed when the size of the foreskin critically decreases, tightly covering the area of the head, not allowing it to be exposed. Treatment for this pathology is surgical. It consists of excision of the damaged prepuce tissue. If this is not done, it is possible to develop complications such as acute urinary retention and paraphimosis.

And another variety - physiological phimosis in a child - is a natural condition, a kind of protective function of the child's body:

• protects the most delicate penile skin from traumatic injury;
• prevents infection;
• Allows the foreskin to produce lysozyme and other immunoglobulins.

The physiological form is typical for 96% of newborn male babies. By the age of one year, such phimosis passes in 30% of children, by 3-4 years - in 70% of children, by 7 years - in 90%. A little more than 1% of boys get rid of physiologic phimosis only by puberty. [7]

Complications and consequences

Physiological type of phimosis, although it can lead to complications, but it happens quite rarely - mainly in case of failure to observe the simplest hygiene rules, overheating of the intimate zone or excessive allergic tendency of the child's body. In such situations, there may be problems with urine output, or the development of inflammation, which requires urgent medical consultation with further more frequent conservative treatment.

Specialized medical attention is needed if a child develops:

• balanoposthitis;
• paraphimosis;
• acute urinary retention.

If you try to forcefully move the narrowed foreskin ring in pathologic phimosis, the glans may become pinched. This condition is called paraphimosis. Paraphimosis is very dangerous, as it is accompanied by a violation of blood and lymph circulation in the genitals, a sharp increase in tissue swelling with further necrosis (necrosis) and the development of purulent processes. In such a situation, medical assistance should be followed immediately: in the case of early pinching, the doctor can try to manually reposition the head (sometimes with the use of anesthesia), and in the case of delayed treatment of the patient, surgical dissection of the narrowed ring with further circumcision is performed. [8]

Balanoposthitis is one of the possible complications of phimosis, which is an acute form of inflammation of the tissues of the glans and prepuce. The complication develops as a result of a significant decrease in the immunity of the child, or against the background of other existing infections in the body.

Distinctive signs of the development of balanoposthitis are considered:

• severe swelling;
• a large area of redness;
• soreness;
• the appearance of pus discharge from the preputial space.

In turn, the consequences of such an inflammatory process can be the formation of scars on the skin, acute urinary retention.

The development of balanoposthitis is a reason to urgently seek medical help, which will allow you to stop the pathology in time and prevent the appearance of new health problems.

Difficulties with urine output can occur if the foreskin has a very narrow opening. In such cases, there is a specific blowing out of the prepuce sac by the pressure of urine during urination. In this case, the jet of liquid is weak, may be interrupted periodically, and in complex cases is released only dripping. At the same time, children complain of painful and unpleasant sensations when going to the toilet. Young children become afraid of these visits, as a result of which secondary enuresis develops. During urination, children behave restlessly, screaming, crying and moaning. [9]

At the first signs of the development of complications in phimosis, it is necessary to visit a doctor without delay: this will allow you to solve the problem faster and easier, with minimal discomfort for the child.

Diagnostics of the phimosis in children

A specialist with experience can diagnose phimosis already during the first examination of the child. Without problems, the degree of development of the violation is also found out. But with the onset of puberty and the beginning of sexual life, differential diagnosis with sexually transmitted diseases (in particular, syphilis) is mandatory.

It is important to distinguish between physiological phimosis and pathological phimosis. In physiological phimosis, the doctor will not detect any irregularities in the urethra and urinary excretion, while in pathological phimosis, scarring changes and fibrous tissue will be visible.

Among laboratory tests, the most common are urinalysis and urethral smear examination with further bacterial examination and determination of sensitivity to antibacterial drugs. The analysis identifies the existing infectious agent, assesses the composition of the microflora.

Instrumental diagnostics is prescribed only when complications develop, as well as to assess the general condition of the body. [10]

Treatment of the phimosis in children

In the vast majority of cases of phimosis, the problem is solved without any outside intervention as the baby grows. But if complications develop, or due to illiterate actions phimosis can become a definite pathology, which will have to be treated with the help of a surgeon. Intervention is performed routinely, after the necessary diagnostic procedures. Most often the operation of choice is circumcision - excision of the preputial leaflets in a circle, or simply - circumcision. [11]

Surgery takes less than half an hour and general anesthesia is used. The foreskin is cut off in a circular line. The remnants of the inner and outer preputial sheet are sutured with self-absorbing material. The operated child can start walking by evening, the urinary process is restored.

So-called laser treatment is essentially the same circumcision, just with slightly different instruments. Local anesthesia, which is performed at the base of the penis, may be sufficient for this operation, although in some cases general anesthesia may also be used. Excision is performed with a laser beam rather than a scalpel: the inner preputial part is separated, the wound is covered with a bandage to prevent infection and the development of edema. The recovery period is the same as after conventional circumcision surgery. [12]

Which doctor should I see?

If we are talking about physiological phimosis and the boy in this case nothing bothers, it is not necessary to go to doctors, as well as independently trying to "develop" the foreskin. The main thing - moderately observe sanitary-hygienic norms, daily wash the external genitals with warm water. The foreskin will be able to open when it is time to do so. With the accumulation of smegma (light mass of curd-like consistency) should not panic, nor do not need to resort to aggressive methods of action. Smegma is usually washed off with a stream of water - for example, from a shower head - which is more than enough.

If the baby voices any complaints - for example, pain and discomfort when excreting urine, or the parents themselves notice that the urinary fluid comes out with difficulty, that the foreskin seems to inflate during urination, and there is redness, abnormal discharge or swelling on the penis, it is necessary to go with the child to the doctor as soon as possible. Optimally - if it will be a pediatric urologist, or a surgeon. Parents are important to pay attention to the fact that the doctor was really qualified, did not resort to unnecessary traumatic manipulations. At first, he will try to solve the problem with conservative methods: reduce the inflammatory reaction, try to soften the skin. Surgery is appointed only if there are really serious indications and if conservative measures are ineffective. As practice shows, most boys with phimosis do not require surgery.

Treatment of phimosis in children without surgery

Until a few years ago (and in some clinics even today), doctors believed that the inability to open the head of the penis in young boys, and even more so in the presence of synechiae, should be considered a disorder, not a norm. Pediatric surgeons insisted that every time the baby's genitals are washed, parents should try to open the head a little, and the accumulated glandular secretion cleaned off to prevent the development of inflammation. Moreover, very often at a routine visit to the doctor followed attempts to forcefully open the head, with a sharp displacement of the foreskin - regardless of the presence of synechiae in the baby. Such manipulation is, of course, very painful, and today is considered inadmissible, because it only aggravates the pathology, if any, and if there is no problem, it creates it.

Modern and competent medical specialists know that the physiological variation of phimosis is normal, and there is no need to do any manipulation (and even more so - surgery). It is a proven fact that premature withdrawal of the head and straightening of synechiae often leads to their repeated formation, but already in a rough scar form. Many young patients have previously gone through multiple repeated re-dissolution of synechiae, which subsequently required surgical assistance - circumcision. Therefore, in the absence of complaints and visible signs of inflammation should not affect phimosis in any way. [13]

Treatment at home

A few years ago, doctors denied the possibility of conservative home treatment of phimosis. Today, along with the known surgical methods of correcting the problem, phimosis is successfully treated conservatively:

• by regular, gradual manual stretching of the preputial tissue;
• by using special stretching devices;
• medically, using corticosteroid ointments to improve the elasticity of the foreskin.

Since such a technique is quite new, not all specialists perceive it positively, so many of them continue to insist on surgical treatment. A large number of unsatisfactory reviews are associated with numerous attempts at self-treatment of patients, which were not always competent and did not have the necessary effect. Moreover, gross errors in manipulation often led to very unfavorable consequences - such as impingement of the head, inflammatory and infectious processes, etc. Few patients also know that conservative methods are not used at all to eliminate the scar type of phimosis.

Nevertheless, with a competent approach and under the care of a qualified doctor, you can cure congenital phimosis even at stages II-III, and quite quickly and successfully. But the fourth stage is likely to be an indication for surgical intervention.

Stretching techniques for phimosis began to be used in practice not so long ago. The general principles of such treatment are as follows:

• self-medication is strictly forbidden;
• A preliminary discussion with the doctor and further supervision by the doctor is necessary;
• Stretching should be as gradual as possible, without pain or discomfort;
• stretching should be done regularly.

One of the most popular methods is the development of the foreskin during morning water procedures: the prepuce is slowly pulled over the head while standing under a warm shower or immediately after urinary excretion. The procedure is carried out until a slight pain occurs, but no more than that.

The second method is finger stretching, the essence of which is the careful introduction of clean fingers into the foreskin cavity with further gradual dilatation. According to experts, such methods help to eliminate congenital phimosis in more than 70% of cases.

Medications

The essence of drug therapy for phimosis is to suppress the focus of the inflammatory process and destroy pathogens. For this purpose may be prescribed:

• ointments and creams for external application;
• Baths with herbal infusions, furacilin, light solution of potassium permanganate;
• vitamin remedies to strengthen the immune system.

In complicated cases, systemic antibiotics and detoxification solutions are prescribed. The choice of drugs is performed individually depending on the characteristics of a particular clinical case.

Topical application of topical corticosteroids (clobetasol propionate or betamethasone valerate) [14]	Apply to the area of the head of the penis once a day until remission is achieved, with further reduction in frequency of application. Possible side effects: tissue atrophy with prolonged use.
Aevit (vitamin preparation)	Take orally for a long time (the dose is selected individually). Possible side effects: individual hypersensitivity reaction.
Multivitamol syrup with lysine and lecithin	Take orally: children 2-4 years old 1 tsp. Twice a day, 4-6 years old 1 dessert spoon twice a day, children from 7 years old - 2 dessert spoons twice a day. Side effects: possible allergic reactions, constipation, stool coloring black.
Bion 3 Kid, vitamins and minerals	Take 1 tablet daily, with food, without chewing, daily for a long time. Allergic reactions are possible.
Vitaton Kids gelatin vitamin pastilles	Children from 4 to 6 years of age take 2 lozenges per day, and from 7 to 13 years of age - 3 lozenges per day. Individual hypersensitivity reactions are possible.

Baths for phimosis in a child

If the doctor diagnosed phimosis in a young patient, then to alleviate the condition it is recommended to take sitting baths with herbal infusions. For this purpose, such medicinal plants as pharmacy chamomile, thyme, sage, calendula, blackberry leaves are perfectly suitable. In the baths allowed to add a little baking soda, but not salt: for baths with phimosis do not use, or ordinary table salt, or sea salt. The duration of the bath - about 15 minutes, the temperature of the water - not hot or cold, comfortable, about 45 ° C.

For water procedures, you can alternate infusions of certain plants, or immediately brew herbal mixtures. If the child does not want to sit in a sitting bath, the remedy can be poured into the general bath, but in a larger volume.

For example, to prepare a sitting version of the bath take 1 tbsp. Sage, pour 200 ml of boiling water, insist for an hour, then filtered, diluted in 1 liter of warm water and poured into a container for sitting. If you need to take a general bath, then prepare a more concentrated infusion: 3 tbsp. L. Sage brewed 0.5 liters of boiling water, insist for an hour and pour into the bath, pre-filtered infusion.

In addition to water procedures can be used water compresses, warm lotions, the basis of which are the same medicinal plants.

Ointments for phimosis in children

If medication is prescribed for phimosis, it is usually in addition to other therapeutic methods. In the vast majority of cases, these medications are corticosteroid ointments.

The prescribed ointment is applied to the area of the head of the penis and to the prepuce tissue, which allows:

• soften and improve the elasticity of the prepuce;
• reduce inflammation, eliminate swelling.

Practical use of such ointments has shown that corticosteroid drugs help speed up the process of eliminating phimosis, heal microscopic cracks in the tissue and relieve pain.

The use of ointments is most indicated for children of adolescence. Contraindications to use may include acute or chronic microbial, viral or fungal infectious diseases.

It should be remembered that corticosteroids are quite strong medications, which with prolonged use can cause the development of some undesirable side effects, in particular:

• thinning of the skin;
• changes in pigment formation, appearance of pigment spots;
• disruption of the capillary network in the area of exposure.

Self-medication or improper use of such remedies can cause systemic negative effects, although in general reviews of such treatment are quite positive.

Let's take a closer look at some of the most popular and common ointments for phimosis treatment.

• Diprosalik

The composition of Diprosalik ointment includes betamethasone and salicylic acid, which helps soften tissues and improves the absorption of the hormonal component. Thanks to this means, with phimosis, a softening and moderate anti-inflammatory effect is provided. Ointment is applied to the preputial area twice a day: in the morning and at night. Contraindications: fungal infections and individual hypersensitivity to the composition of the drug. [15]

• Acriderm

The main component of Acriderm is the corticosteroid betamethasone dipropionate, which promotes early wound healing, destroying the infection. The cream is used three times a day: the drug is applied to the area of the head, gently massaging. The treatment course usually lasts up to 20 days.

• Levomekol

Levomekol contains an antibacterial component chloramphenicol and immunostimulating substance methyluracil. The product has the ability to heal skin microcracks and wounds, restore healthy tissue.

Levomekol is used in the morning and at night (preferably - after a bath or warm shower), for two weeks.

Contraindication to use: allergy, hypersensitivity.

• Hydrocortisone ointment

In phimosis, it is sufficient to use 1% hydrocortisone ointment, the active ingredient of which is hydrocortisone acetate. With regular application daily for three weeks, it is possible to achieve a significant improvement in the extensibility of the skin. The ointment is applied twice a day, after preliminary sanitary and hygienic procedures. Contraindications to the use of the product: mycoses, ulcers and wounds, pyoderma. [16]

• Contractubex

Contractubex gel remedy consists of liquid onion extract, heparin, allantoin. The composition of the drug provides antiproliferative, anti-inflammatory, softening and smoothing effect, helps to eliminate scarring changes in the skin. The drug is applied to the prepuce tissue several times a day and gently rubbed until fully absorbed. The term of use - for several weeks. Contractubex is allowed to use in children, starting from 2 years of age, but it must be done carefully: the drug can cause allergies.

• Advantan

The external drug Advantan is represented by the active ingredient methylprednisolone aceponate. The drug itself is available in two versions:

• cream, which has a more gentle consistency than ointment products:
• Advantan ointment - greasier and thicker, suitable for dry skin.

The duration of treatment of phimosis with this drug is from one to three months: apply cream or ointment once or twice a day, depending on the doctor's recommendations.

Contraindications: skin infections in the area of application.

• Pimafucort

Ointment for external use in phimosis Pimafucort includes hydrocortisone, natamycin and neomycin. Thus, the action of the corticosteroid is enhanced by antibiotics. The drug has an antimicrobial, antifungal, local anti-inflammatory effect, softens the skin. Do not use the remedy in children under one year of age. Application is performed daily, preferably at night. Side effects occur rarely - only on the background of long-term treatment with the drug.

• Celestoderm

Celestoderm ointment is based on betamethasone valerate. It may also include the antibacterial agent gentamicin, which is relevant for the treatment of bacterial complications of phimosis, or at increased risk of their development. Contraindications to the use of the drug: viral and fungal lesions.

Ointment is applied to the foreskin area daily, once a day (in the second stage of phimosis - twice a day).

• Locoid ointment

Lokoid contains hydrocortisone 17-butyrate. The drug may be available in the form of cream and ointment, but in phimosis it is appropriate to use only cream (ointment is undesirable). The drug is applied to the foreskin up to three times a day daily or every other day.

Locoid has a moderate therapeutic effect, rarely causes the development of side effects. Contraindications to the use of the drug include skin infections and atrophic skin changes.

• Betamethasone

Ointment with 0.2% content of betamethasone can be used as an independent remedy for phimosis, or in combination with hyaluronidase cream: such a complex allows you to significantly improve the structure of the delicate skin, reduce the number of elastic fibers. In general, Betamethasone perfectly copes with inflammation and swelling, promotes good stretchability of the tissue. The drug is used twice a day: it is applied to the prepuce area and lightly massaged for five minutes. The total term of the treatment course is usually two weeks.

• Fluorocort

Fluorocort is a synthetic corticosteroid ointment with triamcinolone acetonide, which has a fairly strong anti-allergic and anti-inflammatory property. Usually this drug is prescribed for the treatment of allergic dermatoses, as well as in phimosis. A thin layer of ointment is applied 2-3 times a day. It should not be used in children under two years of age. The drug is used for a short period of time, due to the risk of atrophic processes.

Physiotherapy treatment

Physiotherapy for phimosis is prescribed in order to stop the inflammatory reaction, improve local metabolic processes in the tissues. In general, this type of treatment has a wide range of activity: the effect of procedures is not limited to the point of exposure, but is positively perceived by the whole body. However, there are also contraindications:

• thyrotoxicosis;
• acute infectious diseases.

Physical therapy is carried out against the background of drug therapy, which allows you to complement and enhance the effect of ointments and other topical preparations.

Treatment is prescribed individually, based on age criteria and other characteristics of the patient. [17]

Herbal treatment

Medicinal plants are allowed to be used in phimosis in children, if there is no risk of complications. In addition, it is necessary to consult with a pediatrician before starting treatment.

Such recipes of folk medicine for eliminating phimosis are known:

• Squeeze fresh juice of aloe (centipede), inject it with a syringe (without a needle) into the preputial cavity daily at night.
• Prepare an infusion of calendula: one tablespoon of medicinal raw material poured 200 ml of boiling water, insist under a lid for 30 minutes, filtered. Used in a warm form to put a compress on the problem area (better - at night).
• Make a bath based on herbs: take 1 tbsp. Chamomile color, succession, thyme and calendula, pour 800 ml of boiling water, insist under a lid for twenty minutes, filtered. Used for taking sitting baths. The procedure should last 20-30 minutes. To increase the effectiveness of the infusion is recommended to add ¼ teaspoon of baking soda.

Surgical treatment

If conservative treatment has not led to positive results, and phimosis has not disappeared, the help of surgeons is resorted to. There are several types of interventions that are successfully used for phimosis.

The most common circumcision, or circumcision, is performed as follows:

• to administer anesthesia;
• the tissue in the area of intervention is treated with a disinfectant solution;
• the prepuce is pulled back and secured;
• make an incision and remove the tissue in a circular fashion while maintaining the integrity of the frenulum;
• the rest of the foreskin is sutured.

This type of surgery is a circumferential excision, but there are other ways to intervene:

• Roser's method involves inserting a probe between the head of the penis and the inner preputial leaflet with further dissection of the two leaflets and suturing of their remnants.
• Schloffer's method consists of dissecting the outer preputial sheet from the orifice to the sulcus, followed by dissecting the inner sheet, unrolling the foreskin, and suturing the remnants transversely.

In addition to these methods, removal can also be performed using a laser. In this case, the operation is performed as usual, but instead of a scalpel, the surgeon uses a laser beam.

An alternative to laser excision can also be a radio wave method, which involves the use of a radio wave generator - in particular, the Surgitron apparatus.

Phimosis in children after surgery is completely corrected, recurrences and complications do not occur. [18]

Anesthesia for phimosis in children

In children, surgery to remove phimosis is best performed using general anesthesia. Even if the doctor says that local anesthesia will be enough, it is still better not to risk and agree only to general anesthesia. After all, the child quite imagines what the operation is, he experiences fear, mental and physical discomfort, and in most cases during the intervention will scream, cry and even try to break free. All this is no less stressful for the child's body than general anesthesia. Therefore, it is better to think carefully, weigh all the pros and cons, and only then decide on anesthesia.

What's also important:

• for general anesthesia in children use modern drugs of new generation, low-toxic, hypoallergenic, which allow to perform anesthesia without any negative consequences;
• all possible negative reactions from the child's body are taken into account, laboratory and instrumental diagnostics is performed beforehand, which allows to clearly calculate the necessary dosage of drugs for anesthesia;
• all vital signs (blood pressure, heart rate, pulse rate, etc.) must be monitored during the operation.

How long does surgery for phimosis in a child last?

The operation usually lasts 20-30 minutes, less often up to 40 minutes. This depends primarily on the method of anesthesia and the speed of onset of anesthesia.

Prevention

Prevention of phimosis is based on compliance with the simplest and accessible recommendations;

• It is necessary to walk often with the child, provide physical activity;
• observe the rules of intimate hygiene, wash the external genitals of the baby once a day (it is important to remember: excessive fanaticism in hygiene is also not welcome);
• Ensure that the child receives a nutritious diet, with all the necessary vitamins and minerals;
• do not allow the foreskin to be forcibly displaced, do not touch the genitals if the child is not bothered and there are no external unfavorable signs;
• treat infectious and inflammatory diseases in a timely manner, visit the doctor regularly.

Forecast

Phimosis is a fairly common phenomenon in children, although in the vast majority of cases it is physiological and does not require any intervention. The pathological variety of phimosis can be associated with infectious-inflammatory, traumatic, skin problems. In this regard, the diagnosis can be made by both a pediatric urologist and a surgeon, infectious disease specialist, dermatovenerologist.

With physiological narrowing of the foreskin opening, the prognosis is favorable: with age, the situation normalizes and the head begins to open freely. In the presence of pathology, the outcome depends on the underlying cause of the disorder and the timeliness and completeness of treatment. In the vast majority of cases, asymptomatic uncomplicated phimosis in children is cured and eliminated independently.