Phimosis and circumcision in children

Phimosis is the inability to pull the foreskin over the glans, it can appear as a tight ring of foreskin around the tip of the penis, preventing full retraction. It may be congenital or may occur later in life when it is called acquired phimosis.

How is phimosis diagnosed?

The diagnosis is made by clinical examination.

• When the skin is pulled, the glans are not visualized or only partially visualized
• There is a narrowing of the foreskin in the form of a ring
• Sometimes a skin balloon is made during urination
• The skin often bursts and cracks are formed

Can phimosis be associated with other conditions?

Often phimosis is not an isolated problem, but is associated with some of the following pathological entities that must be addressed, along with resolving the phimosis.

• Lichen sclerosus (skin disease with loss of foreskin elasticity)
• Adhesions between the foreskin and the glans
• Short frenulum

What complications can untreated phimosis cause? 

• Repeated glans infections
• Inflammation of the penis
• Urinary retention
• Recurrent urinary infections
• Paraphimosis - An emergency, when the foreskin can no longer be pulled forward over the tip of the penis.

How is phimosis treated?

Treatment may be nonoperative and operative. Non-operative treatment involves lubrication of corticosteroid creams. Today, creams are prescribed in safe quantities and without systemic effects on the body. One treatment cycle lasts four weeks. If a positive response is received, it may be permanent or temporary, when it is possible to delay definitive surgery. Surgical treatment is necessary if the phimotic ring has not expanded and the skin cannot be pulled after the cream treatment and an intervention called circumcision is being done. The goal of circumcision is to achieve complete functionality with an aesthetically good result.

What is Circumcision?  

Circumcision is a surgical intervention that removes the excess foreskin of the penis. The goal of circumcision is to achieve complete functionality with an aesthetically good result. 

What are the reasons for doing circumcision?

• Phimosis - Phimosis is the inability to drag the foreskin over the glans due to a narrow prepuce.
• Paraphimosis - Paraphimosis is the inability to return the narrowed foreskin back over the glans, conditionally speaking, there is a "stuck" skin above the glans. It represents an acute surgical condition and an emergency manual repositioning or circumcision is performed.
• Aesthetic reasons - A prepuce that is too long, frequent infections or scars are an indication for surgical treatment - circumcision.
• Traditional reasons - Some confessions and national communities perform circumcision for traditional reasons. Depending on the nation, ritual circumcision is performed at different ages.

At what age is circumcision performed? 

Circumcision is performed in the earliest infancy only if the infant has recurrent urinary infections. The child is then operated under general anesthesia. The optimal period for performing circumcision is school age. The child is big enough to understand what it is and is in the mood to cooperate. The intervention is performed at a younger age under general anesthesia, and in the older school age (from the age of 12) it is possible to perform the intervention under local anesthesia, the so-called penile block. 

What does the intervention look like? 

The operation is performed under local or general anesthesia, depending on the age and preference of the patient. The narrowed part of the foreskin is surgically removed, and thin sutures are placed on the wound that break down on its own, so no removal is required by the surgeon. The penis is dressed with a special bandage, which has the role of preventing swelling and bleeding. The patient is able to go home several hours after the intervention if the intervention was performed under general anesthesia, or half an hour after the intervention was performed under local anesthesia. 

Postoperative recovery 

Prescribing pain therapy as well as topical antiseptic to maintain hygiene. Sometimes there is an indication for antibiotic therapy. The compression bandage is being changed every second or third day and removed on the seventh postoperative day. Adult patients are advised to abstain from sexual intercourse for the next 4 weeks. The aim of the operation is to achieve excellent, functional and aesthetic results.