Dr. Juan Carlos Salarich Pedemonte is a pediatric surgeon and belongs to Top Doctors, the select circle of top doctors in Spain. As an expert in phimosis, he will explain the details of this surgery.
What is phimosis?
Phimosis is the inability of the foreskin to retract and the glans to appear. There is a ring of strangulation that retracts the foreskin and prevents the glans from being revealed. The foreskin and glans are formed in the child in the tenth or eleventh week of gestation and when the child is born he has a physiological phimosis, that is, only 4% of newborns could retract the foreskin. Up to one year of life it is considered that not being able to retract the foreskin is physiological, it is not a pathology, after one year of life if the foreskin cannot be removed, circumcision should be performed.
Can phimosis appear as an adult?
Yes, phimosis can appear in the adult as soon as the foreskin of the adult may have suffered some injury, some wound, some abrasion, which when repaired produces a fibrosis and produces a strangulation ring and therefore the glans will not be able to appear when there is retraction of the foreskin. This causes a lot of discomfort, both balanopreputial infections and lack of hygiene, as well as being prone to suffer from penile calcinoma due to a lack of being able to uncover and clean the penis correctly.
What symptoms advise treatment in phimosis?
The main symptom would be balanitis. Infections of the balano-preputial groove produce pain, redness, purulent secretions, and even urine infections that can affect the kidneys themselves. Another symptom would be paraphimosis: when the foreskin is retracted, it can be detached from the glans penis, but once the glans penis has passed, there is such a strong strangulation ring that the glans penis cannot be covered by the foreskin and there is a stenosis that causes a lack of irrigation to the glans penis. It is an urgent intervention, since the glans penis is suffering and the tissue cells of the glans tissue will be deprived of oxygen and they may degenerate. Not being able to retract the foreskin is sufficient symptomatology for circumcision intervention.
Let us think that if this is prolonged later on, the man will have difficulties and the sexual relations he may have will be painful and not pleasant. Therefore I recommend to all boys who have phimosis to practice circumcision.
Sometimes this circumcision is not done for medical reasons but for religious and cultural reasons. There are religions and cultures that practice circumcision at birth or a few days after birth.
What does circumcision or post-ectomy consist of?
Circumcision consists in the resection of the foreskin below the strangulation ring so that the glans is uncovered. Several techniques can be used for this purpose. Nowadays there are devices designed to perform circumcision on the newborn. The most common is to make the resection below the ring with scissors or a scalpel, then hemostasis is controlled by placing some resorbable stitches that will fall after a few days, some creams and dressings are applied for a week and after a week it is practically healed and the post-operative process of the intervention is finished.