Phimosis Therapy

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Phimosis Therapy
Phimosis Therapy
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Phimosis: Diagnosis & Therapy

In an initial conversation with the patient / parents, the doctor collects the medical history, followed by a physical examination. It is checked whether the foreskin can be pushed back completely or partially over the glans and a ring can be seen when sliding back over the glans. If there is already an inflammation, a smear is taken from the inflamed area and examined microscopically for germs…

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  • Continue reading
  • more on the subject
  • Advice, downloads & tools
  • Different treatment options
  • Non-surgical treatment
  • Operative therapy methods
  • How long does the healing process take?
  • Risks & Complications
  • Circumcision for traditional reasons
  • Whom can I ask?
  • How are the costs going to be covered?

Different treatment options

There are several options available for treating phimosis (narrowing of the foreskin). The therapy recommendation depends on the age of the patient and the severity of the phimosis. Therefore, a distinction is made between the treatment of children and that of adults.

Since an adhesive foreskin or a tight foreskin is a natural condition in babies and small children, in most cases there is a wait - as long as there are no problems such as recurring urinary tract infections, inflammations, etc. If the phimosis persists beyond infancy or if symptoms occur, ointment therapy (e.g. with cortisone) can be useful. Success rates of up to 80 percent can be achieved.

Note Opinions on when to treat phimosis in children vary widely. The current trend clearly shows a wait-and-see attitude. The recommendations are to only perform an operation between the ages of eight and ten.

Non-surgical treatment

Not every narrowing of the foreskin needs to be treated surgically and immediately. In the case of non-surgical treatment, an attempt is made to widen the tightness with ointment with cortisone or estrogen ointment, as far as this is painless and possible without resistance. This measure is carried out over a longer period of time (approx. Four to eight weeks). Then you can begin to carefully push back the foreskin - avoiding tears. If the phimosis persists, a triple incision (method of foreskin enlargement, in which three incisions are usually made across the narrowing) or a foreskin removal is performed.

Operative therapy methods

Different surgical procedures are available for both children and adults.

Complete circumcision

With complete circumcision (circumcision), the foreskin (outer and inner sheets) is completely or partially removed in a surgical procedure so that the glans is then exposed. This can be done under local anesthesia as well as under general anesthesia (especially recommended for children).

The reasons for circumcision in children can include severe impairment of the urine stream (e.g. ballooning of the foreskin while urinating) and the resulting recurring urinary tract infections. In older children, pain when pulling back too tight a foreskin can also be reasons for circumcision. In adults, the causes of phimosis are mostly inflammatory changes such as scarring after recurring foreskin infections. Injuries caused by forcible attempts at retraction (pulling back) can also increase the foreskin constriction and make an operation unavoidable.

See Phimosis: Causes & Symptoms for complete details.

Foreskin-preserving procedures

With economical circumcision (plastic circumcision) the narrow part of the foreskin is removed. Part of the foreskin remains and covers the glans. The remaining foreskin must then be able to move easily over the glans.

Note This method of pruning is a risk of recurrence of phimosis due to the surgical scar (relapse).

Extension plastic

Enlargement plastic is one of the foreskin-preserving procedures. The tightness of the forehead is treated with enlargement sculptures (e.g. longitudinal incisions that are sewn across). Here, too, there is a risk of a so-called relapse.

Note Lichen sclerosus (inflammatory skin disease that leads to hardening of the foreskin) or other chronic inflammations exclude foreskin-preserving procedures because of the high risk of relapse.

How long does the healing process take?

As a rule, the healing process for a complete circumcision is completed after two weeks. With the help of disinfecting hip baths or limb baths - from the first day after the procedure - the healing process can be additionally supported. You can take a shower three days after the procedure. A full bath is only indicated after the threads have dissolved (between seven and twelve days). If the healing process is good, sexual intercourse is usually possible again after three weeks. If you experience slight pain after the operation, pain medication can be taken. Pain relieving suppositories are also available for children.

Note In the event of redness, increasing swelling or fever, however, a doctor should be consulted.

Risks & Complications

Circumcisions are relatively few in complications. Immediately after the procedure, there may be minor bleeding, as the foreskin is very well supplied with blood vessels. In rare cases, massive bleeding occurs. These must be treated surgically, in most cases a short-term pressure bandage is sufficient. Postoperative edema can appear more or less pronounced after the operation. These are usually of short duration and do not require treatment.

Wound infections are rare and can be treated with antibiotic ointments. The scarred narrowing of the urethral opening (meatal stenosis) is also one of the rare complications after circumcision. It can occur primarily in connection with lichen sclerosus (inflammatory skin disease). Meat stenosis can be recognized by a very thin stream of urine. There is a possibility of impaired sensitivity of the glans. However, this only rarely leads to sexual restrictions or complaints.

Other possible risks:

  • Relapsed phimosis: This is a recurrence of the foreskin narrowing. This usually only occurs with foreskin-preserving procedures.
  • Wound dehiscence: the row of sutures diverges (rarely)

Circumcision for traditional reasons

In addition to the medically necessary circumcision, there are other reasons for removing the foreskin. Most of these reasons include traditional and religious beliefs. In Judaism, circumcision has a mainly religious meaning. For example, Jewish boys are circumcised on the eighth day after their birth. The circumcision is usually carried out by a circumcision specialist (so-called mohel). There is also a tradition of circumcision in Islam. It is rooted in the Muslim faith and is also understood as a cleanliness requirement. In Islam there is no set time for circumcision.

Whom can I ask?

If you suspect a foreskin constriction, you can contact the following offices for diagnosis and treatment:

  • General practitioner
  • Specialist in urology
  • Pediatrician

How are the costs going to be covered?

The costs for a medically justified circumcision are covered by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

When hospitalization is required

Hospitalization may sometimes be required for treatment. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

Note The costs for a cosmetic or religious circumcision are not covered.

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