A tight foreskin is also medically known as phimosis if it cannot be retracted to fall behind the glans penis. This condition is a common observation among infants and toddlers. For a long time, the main form of treatment has been through circumcision. This is, however, changing and parents are opting for other forms of management. We will have a look at some of the ways 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.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
There are a number of reasons as to why circumcision may not be preferred by a number of parents. One of them is cultural practices where the parents are against the practice as a cultural belief and would only have it if there were no other options available. Some patients may have genital malformations such as epispadias and hypospadias for which the foreskin is used in surgical correction. The foreskin cannot, therefore, be removed before this operation.
Circumcision is at times the right procedure to be undertaken but may not be carried out for one reason or the other. For instance, the parents may decline it on cultural grounds which means that an alternative must be sought. Circumcision is also considered inappropriate when the foreskin is to be preserved for future operations such as the corrective of urethral abnormalities (hypospadias and epispadias).
Conservative surgery also has its place. This is a procedure in which only part of the skin is incised while the rest is left intact. An example is prepu-tioplasty which involves the creation of a small incision on the upper part. Others include frenulotomy and meatoplasty. The main benefits include, quicker recover, less cost and simplicity. The downside is that phimosis may recur.
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.
Phimosis has been treated through circumcision for many years. This has been changing recently for a number of reasons. Some of these reasons include the fact that circumcision is quite costly and is associated with surgical risks. A number of alternatives to circumcision now exist and these offer some advantages. All the alternatives should be considered before a final decision on what is most appropriate is made.
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.
There is a need to differentiate between the two forms of phimosis because the management varies. The physiological type is transient and affects mainly younger children while the pathological type will persist if an intervention is not undertaken. Physiological phimosis is usually responsive to conservative methods of treatment while the pathological type will more often than not require surgical correction.
There are a number of reasons as to why circumcision may not be preferred by a number of parents. One of them is cultural practices where the parents are against the practice as a cultural belief and would only have it if there were no other options available. Some patients may have genital malformations such as epispadias and hypospadias for which the foreskin is used in surgical correction. The foreskin cannot, therefore, be removed before this operation.
Circumcision is at times the right procedure to be undertaken but may not be carried out for one reason or the other. For instance, the parents may decline it on cultural grounds which means that an alternative must be sought. Circumcision is also considered inappropriate when the foreskin is to be preserved for future operations such as the corrective of urethral abnormalities (hypospadias and epispadias).
Conservative surgery also has its place. This is a procedure in which only part of the skin is incised while the rest is left intact. An example is prepu-tioplasty which involves the creation of a small incision on the upper part. Others include frenulotomy and meatoplasty. The main benefits include, quicker recover, less cost and simplicity. The downside is that phimosis may recur.
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.
Phimosis has been treated through circumcision for many years. This has been changing recently for a number of reasons. Some of these reasons include the fact that circumcision is quite costly and is associated with surgical risks. A number of alternatives to circumcision now exist and these offer some advantages. All the alternatives should be considered before a final decision on what is most appropriate is made.
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