Phimosis is a condition that is characterized by a narrow foreskin of the penis that makes it impossible to retract it behind the glans penis. It is a fairly common problem in male infants. The commonest form of management for the condition is circumcision. Non surgical methods also exist and can be used for some patients. In this article, we will look at the options that can be used to Relieve tight foreskin without circumcision.
There is a need to have a proper diagnosis before any decisions on treatment can be arrived at. This is largely a clinical diagnosis with laboratory and radiological investigations only playing a minor role. Naturally occurring adhesions between the glans penis and the prepuce are responsible for the majority of cases of phimosis. This category is therefore also known as physiological phimosis. It can be distinguished from pathological phimosis occurring due to disease processes.
It is important for the physician to clearly understand the difference between the two types. This is because the management will vary depending on the exact type involved. In general, the physiological type can be easily managed by conservative treatment options while the pathological type will require surgical intervention in the form of circumcision. Without intervention, the pathological type has the potential to result in a wide range of complications.
Even in situations where there are clear indications for circumcision, some parents may decline the procedure for one reason or the other. Commonly, they will cite cultural reasons where the practice goes against their beliefs. More importantly, the procedure may not be appropriate in cases where, the fore skin is required for corrective plastic surgery. This is common for conditions such as epispadias and hypospadias.
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.
Dilation and stretching of the prepuce is a commonly performed alternative. This procedure can be easily carried out by a doctor in an outpatient department. Advantages include that it is cheap, effective, less painful and quite safe. It is usually carried out after applying local anaesthetic agent into the prepuce. The technique may not work that well in the presence of fibrosis or infection.
Topical steroids are another effective option. The success rates associated with steroid use tend to range between 65 and 95 per cent. The mechanism involved is quite unclear but a substance referred to as lipocortin is believed to be involved in mediating local anti immunity and anti-inflammatory actions. The main downside is that the steroids may result in skin thinning.
Circumcision is the mainstay of treatment for non retractable penile foreskin. However, due to the risks and costs associated with it, some parents and physicians would rather opt for other alternatives. The important thing to remember is that the major determinants of the option to be undertaken are the exact type of the problem and the severity of symptoms. A decision can only be made after considering the merits and demerits of each option available.
There is a need to have a proper diagnosis before any decisions on treatment can be arrived at. This is largely a clinical diagnosis with laboratory and radiological investigations only playing a minor role. Naturally occurring adhesions between the glans penis and the prepuce are responsible for the majority of cases of phimosis. This category is therefore also known as physiological phimosis. It can be distinguished from pathological phimosis occurring due to disease processes.
It is important for the physician to clearly understand the difference between the two types. This is because the management will vary depending on the exact type involved. In general, the physiological type can be easily managed by conservative treatment options while the pathological type will require surgical intervention in the form of circumcision. Without intervention, the pathological type has the potential to result in a wide range of complications.
Even in situations where there are clear indications for circumcision, some parents may decline the procedure for one reason or the other. Commonly, they will cite cultural reasons where the practice goes against their beliefs. More importantly, the procedure may not be appropriate in cases where, the fore skin is required for corrective plastic surgery. This is common for conditions such as epispadias and hypospadias.
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.
Dilation and stretching of the prepuce is a commonly performed alternative. This procedure can be easily carried out by a doctor in an outpatient department. Advantages include that it is cheap, effective, less painful and quite safe. It is usually carried out after applying local anaesthetic agent into the prepuce. The technique may not work that well in the presence of fibrosis or infection.
Topical steroids are another effective option. The success rates associated with steroid use tend to range between 65 and 95 per cent. The mechanism involved is quite unclear but a substance referred to as lipocortin is believed to be involved in mediating local anti immunity and anti-inflammatory actions. The main downside is that the steroids may result in skin thinning.
Circumcision is the mainstay of treatment for non retractable penile foreskin. However, due to the risks and costs associated with it, some parents and physicians would rather opt for other alternatives. The important thing to remember is that the major determinants of the option to be undertaken are the exact type of the problem and the severity of symptoms. A decision can only be made after considering the merits and demerits of each option available.
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