Phimosis surgery: when indicated, methods, operations, recovery

Surgery intended for pathological phimosis forms of narrowing of the foreskin, after exposure of the glans impossible, too painful, a violation of the sexual life, often provoke inflammation. The general treatment may be regarded as circumcision, which today is carried out not only in the traditional way, known since ancient times, but with the help of modern technology and laser surgery.

surgery for phimosis

Phimosis is a pathological when the foreskin can not move to a full exemption from the skin of the glans penis. As a physiological phenomenon, it is typical for the newborn period and early childhood, and become pathological in adults, men and adolescents after puberty, including the background of the cicatricial and inflammatory changes.

A variety of support measures and methods of pain relief

Surgical treatment, when the disease, phimosis is just a drastic measure to get rid of pathology. According to statistics, about a quarter of adult men have undergone circumcision for this reason. This disease has a number of different functions, the choice of which is determined by the age, period, type and severity of illness, medical training and equipment to operate.

Our day practice:

  • Around the surgery;
  • praeputium;
  • Meatoplasty.

Treatment can take place conventionally, i.e. using a knife, a modern way of laser. The traditional treatment is available, relatively cheap, and it can be done from anywhere in the hospital, where the urologist, but it is not the limitations:

  1. Long recovery, due to higher trauma;
  2. Higher risk of complications;
  3. Required time limit of sexual life;
  4. The risk of scarring space for sewing.

Indications and contraindications for surgery

Indication for surgical treatment is considered pathological phimosis in boys and adult men, all the complex forms of the disease in patients of any age, and relapses inflammation of the foreskin and the glans of the penis condylomatous, foreign objects under the foreskin.

Those obstacles:

  • Severe decompensated pathology of the internal organs, until stabilization of the disease;
  • Acute infection;
  • The pathology of hemostasis;
  • Ulcerative skin lesions in the area of the foreskin (temporary contraindication);
  • Structural changes of the penis (Hypo - and epispadias) — required plastic;
  • Infection of the urinary tract and genital organs (acute or chronic relapse) — to improve.

Preparation for surgery

Before the planned surgical treatment of phimosis in a child or adult will be given a list of required tests — blood tests, urine, ECG, chest x-rays, studies infection, etc. depending on the age. They can be completed at residence in the clinic. Mandatory detention therapist or pediatrician about it, not general topics. When planning general anesthesia, the patient belongs to the second and the anesthesiologist revealed that the presence of allergies, experience with anesthesia in the past, the names of the medication.

phimosis operation

2 weeks before treatment is withdrawn the funds, that make the blood more fluid. The house in the morning of the intervention need to carefully wash the genitals with warm water and mild soap, adult males, hair in the pubic area and groin are removed independently at home, avoiding breaks in the skin or in the hospital, parents take their children to the clinic for diapers, wipes and other necessary baby bath products. If the planned intervention under general anesthesia for 8 hours before and in the morning immediately before surgery can not eat or drink.

After admission, you will need to sign the relevant documents, sign a written consent (the patient or the parents of a son), talk again to the urologist and anesthesiologist, which may take 2-3 hours, so it is better to arrive there in advance. Working with patients-men must release this day at work, because even if quickly perform the procedure as soon as the "run" action is not likely to succeed.

Adult men have reported that after removal of phimosis they can't run, not only because of the surgical trauma, but to an even greater extent, since the introduction of sedatives or drugs for anesthesia. In this connection, you need to consider in advance how you will get home.

Technical activities

During the procedure the patient will lie on back with legs divorced. The surgeon proceeds to the manipulation after the onset of total anesthesia. If a local anesthetic gel, it is applied in advance, and blockade of nerve roots at first limited field of action, the skin is treated with antiseptic, and then the nerve is injected with anesthetic.

Regardless of the chosen technique for the removal of phimosis, the operation area is treated with iodine, and surgery is not limited to penis — processing is necessary and the stomach, and the skin of the scrotum, and thighs. After the patient harboring the sterile linen, which not only closed the place, which will host manipulation.

Expand the narrowed opening of the foreskin, the surgeon removes the clips. When that takes skin back to the exposure head, in the presence of the adhesions — they should be separate. If you are going to circumcised after these actions the expert contour line, which continues to operate with a knife.

Circumcision

One of the oldest and most widespread interventions used for the treatment and prevention of phimosis, and religious reasons, is circumcision. Developed many techniques to perform, but the choice is always the surgeon, who will assess the clinical situation and the technical possibilities of treatment.

The type of circumcision:

  1. Method dorsal slit;
  2. The action, which is used in the clamp;
  3. Circular resection.

Indications for the use of the back slit is phimosis and paraphimosis. The advantages of this surgery is possible to perform alone without the second surgery and low risk of complications, but there is a serious drawback: the surgeon should be experienced and possess the necessary skills in this type of activity.

The dorsal slit technique involves several steps:

  • Overlay clips with the foreskin;
  • The dissection of the skin of conditional 12 hours;
  • Leather trim on the marked line, stitches.

During the manipulation of the vessels are combined and then laid on the wound sterile dressing is applied.

The application clip is considered a technically simple approach, which does not require the presence of another surgeon, the disadvantage is however it is considered likely unsatisfactory aesthetic result some time after the intervention.

In applying the clamp, the surgeon first grasps the skin with the clips, drag it to the desired cutting length. Then the straight clamp fixes the foreskin and cut it off close to the head of the penis. After cutting, the skin is given back and secured with sutures. The conclusion of a careful hemostasis a sterile bandage.

Circular resection technique is very accurate, but requires a good skill of the surgeon, its features and the presence of the assistant. It is used in the development of the subcutaneous veins, because it provides a lower risk of bleeding.

Circular resection of the first, the surgeon marks the incision lines on the edge of the head and the point of attachment of the foreskin, then makes an incision along these lines skin flap, separating it from the penis. After removal of the skin sutures, uniting the vessels, the wound is covered with sterile cloth.

different functions and entries

Newborns and babies first years of life, surgeons strive to apply the non-traumatic varieties to use special pliers.

The Clip is a plastic device disposable, which resembles a bell. This technique is attractive because it does not need to sew. During surgery the urologist will make a vertical incision from the free edge of the skin in the direction of the root of the penis mental for 12 hours, then put on the head of the clip, which is covered with leather, attached to the wire. The excess foreskin is cut off, and the handle of the "clock" is. About a week the plastic ring itself subsides.

The clips are designed for multiple applications, but their use of the pathological form of the disease is very limited. Today experts-urologists resort to them less often. Children when using these clips, the seams do not overlap, and adults think possible erection necessary the edges of the wound to close.

praeputium

Circumcision alternative method of surgical treatment of phimosis is considered the praeputium, which is limited to cases with a cicatricial changes touched only the tip of the foreskin. This operation phimosis in an outpatient setting, takes about 20 minutes and gives less result and less pronounced pain.

Only plastic surgery of the foreskin can become excessive contraction and fibrosis, when such use could trigger a relapse of the disease.

Technology praeputium includes several consecutive steps:

  1. make a small longitudinal incision of the foreskin towards the root of the penis, the magnitude of the surgery should ensure free exposure to the head from the skin during its backward movement;
  2. if a cicatricial phimosis, the surgeon parallel to the skin incision dissecting the fibrous adhesions;
  3. sewing on the skin, which provides exposure to the head.

Meatoplasty

Meatoplasty is a method of surgical correction of the narrowing of the opening of the urethra. It works to complement other procedures, if the phimosis is a narrowing of the urethra, the last part. This happens with severe phimosis as a result obliterating balani you.

When Meatoplasty surgery produce a cystoscopy to examine the urethra hysteroscopy and removal of stenosis in other areas. If one is not found, the patient needs surgery to extend the urethra – stenting.

Treatment of phimosis laser

In recent years, medicine widely used in laser, and urology is no exception. Laser technology for the removal of phimosis involves the use of a laser instead of a scalpel and scissors. Light flow causes heating of tissue, water evaporation and the destruction of the cells, which act like a cutting tool. The technical operation is similar to traditional circumcision.

Laser circumcision has several important advantages:

  • Give fewer complications (infection, bleeding);
  • The pain is reduced;
  • It has a high accuracy;
  • The rehabilitation period is shorter (3-4 days vs a week and a half in normal operation);
  • Shorter intervention (up to half an hour).

Experts say that laser treatment to prevent damage to vessels heavy bleeding, like a beam of light heats and seals the walls, so this method is selected in the pathology of clotting in a patient or high risk of bleeding. By the way, it was first applied in Israel for the treatment of a boy with haemophilia.

Disadvantages of laser treatment is considered to be low availability due to high cost of equipment that you can afford a single clinic, need for experts, who know the technique of laser treatment of phimosis, as well as the high cost of the operation to the patient.

After surgery

When the operation is over, operate transportyou to the recovery room stay, where he will spend a couple of hours without any complaints or signs of complications. If all goes well, it is to go home the same day. Otherwise, the hospital must keep.

use clips

Operative treatment of phimosis is not considered traumatic and it is not limited to the activity of patients, but experts-urologists still recommend the first few days lying in bed: lying down to reduce swelling of the genital tract. Fixation of the penis need to wear tight underwear.

Regardless of the chosen technique, for each type of action involves wearing a bandage (bandage). He needs to be the first several days to protect the penis from dirt and also to prevent strong swelling. The bandage is applied so that the opening of the urethra is not closed and if the urination.

A few days later, the bandage can be removed the physician or the patient (parents). If he had time to dry and adhere to the skin, it should be moistened with antiseptic (chlorhexidine, for example), and only then gently separated. Sloppy and forced removal of dressings can cause damage to the mucous membranes of the body, and complications.

The bandage is removed a few days later. The Penis is swollen and slightly enlarged, it should not cause fear. Swelling can last for weeks, but then gradually go away. Surgeons usually use threads, which do not need to be removed because they resolve themselves, but if they are not resolved after 10 days of recovery time, they must be removed at the doctor.

Regular stitches after surgery will be removed at the end of the first week or a little later. Better, if you remove them the surgeon who performed the intervention. Still, he controls the process of reform.

The treatment effect can be estimated not at once, because you need to recover for quite a long time — sometimes up to six months. Currently, the possible complications — abscess, hemorrhage with bruising, pain during erection, severe scarring along the seam.