Phimosis ,paraphimosis ,circumcision.pptx
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Phimosis ,paraphimosis ,circumcision.pptx
- 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide.
- 3. Learning Objectives 1. Introduction & History 2. Relevant Anatomy, Physiology 3. Aetiology 4. Pathophysiology 5. Pathology 6. Classification 7. Clinical Features 8. Investigations 9. Management 10. Controversies 11. Prevention 12. Guidelines 13. Take home messages
- 5. Introduction & History. • Inability to retract the distal foreskin over the glans penis. • Physiologic phimosis occurs naturally in newborn males • Pathologic phimosis defines an inability to retract the foreskin after it was previously retractible or after puberty. • Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus
- 6. Aetiology
- 7. Aetiology • Idiopathic • Traumatic • Infections /Infestation • Neoplastic (Benign/Malignant) • Congenital/ Genetic • Nutritional Deficiency/excess • Autoimmune • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
- 8. Etiology • Idiopathic • Congenital • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative
- 9. Etiology • Poor hygiene and recurrent episodes of balanitis or balanoposthitis lead to scarring of preputial orifices, leading to pathologic phimosis. • Forceful retraction of the foreskin leads to microtears at the preputial orifice that also leads to scarring and phimosis. • Elderly persons are at risk of phimosis secondary to loss of skin elasticity and infrequent erections • Penile piercings increase the risk of developing paraphimosis if pain and swelling prevent reduction of a retracted foreskin
- 10. Aetiology of Aetiology • Idiopathic • Traumatic • Infections /Infestation • Neoplastic (Benign/Malignant) • Congenital/ Genetic • Nutritional Deficiency/excess • Autoimmune • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
- 11. Pathophysiology
- 12. Pathophysiology • The foreskin cannot be retracted proximally over the glans penis. • In physiologic phimosis, the preputial orifice is unscarred and healthy appearing. • In pathologic phimosis, a contracted white fibrous ring may be visible around the preputial orifice
- 13. Pathophysiology • The foreskin is retracted behind the glans penis and cannot be replaced to its normal position. • The foreskin forms a tight, constricting ring around the glans. • Flaccidity of the penile shaft proximal to the area of paraphimosis is seen (unless there is accompanying balanoposthitis or infection of the penis).
- 14. Pathophysiology • With time, the glans becomes increasingly erythematous and edematous. • The glans penis is initially its normal pink hue and soft to palpation. As necrosis develops, the color changes to blue or black and the glans becomes firm to palpation. • With time, impairment of venous and lymphatic flow to the glans leads to venous engorgement and worsening swelling. As the swelling progresses, arterial supply is compromised, leading to penile infarction/necrosis, gangrene, and eventually, autoamputation
- 16. Clinical Features • Demography • Symptoms • Signs • Prognosis • Complications
- 17. Demography
- 18. Demography • Up to 10% of males will have physiologic phimosis at 3 years of age, and a larger percentage of children will have only partially retractible foreskins. • One to five percent of males will have nonretractible foreskins by age 16 years
- 19. Symptoms
- 20. Symptoms • Painful erections, dyspareunia • Hematuria • Recurrent urinary tract infections, • Preputial pain, • Weakened urinary stream. •
- 21. Paraphimosis
- 22. Paraphimosis • The foreskin is retracted behind the glans penis and cannot be replaced to its normal position. • The foreskin forms a tight, constricting ring around the glans. • Flaccidity of the penile shaft proximal to the area of paraphimosis is seen (unless there is accompanying balanoposthitis or infection of the penis). • With time, the glans becomes increasingly erythematous and edematous. • The glans penis is initially its normal pink hue and soft to palpation. As necrosis develops, the color changes to blue or black and the glans becomes firm to palpation.
- 23. Paraphimosis •
- 24. Prognosis
- 25. Prognosis • Morbidity • Mortality rate • 5 year survival in Malignancy
- 26. Complications
- 27. Complications • Bleeding. • Retention of urine • Infection.
- 28. Investigations
- 29. Investigations • Laboratory Studies – Routine – Special • Imaging Studies • Tissue diagnosis – Cytology • FNAC – Histology – Germ line Testing and Molecular Analysis • Diagnostic Laparotomy.
- 33. Investigations in Malignancy • For diagnosis • For staging • For Screening • For Monitoring
- 34. Diagnostic Studies Imaging Studies • X-Ray • USG • CT • Angiography • MRI • Endoscopy • Nuclear scan
- 36. Differential Diagnosis • Acute Angioedema • Allergic Contact Dermatitis • Anasarca • Balanitis • Balanitis xerotica obliterans • Cellulitis • • Foreign body tourniquet, including hair, thread, metallic object, or rubber bands • Insect Bites • Penile carcinoma • Penile fracture • Penile hematoma
- 37. Management
- 38. Paraphimosis Emergency management • Manual reduction • Puncture method • Hyaluronidase method • Aspirate 3-12 mL of blood from the glans • Vertical incision
- 39. Paraphimosis Emergency management • Manual reduction facilitated by- – ice and/or hand compression on the foreskin, glans, and penis – Soaking the penis in a glove full of ice for 5 minutes before attempting manual reduction – An elastic bandage can also be wrapped from the glans to the base of the penis for 5-7 minutes to minimize edema – Noncrushing clamps – Osmotic method • Granulated sugar • 50% dextrose
- 43. Circumcision:Introduction & History. • Circumcision of males involves removing the prepuce. • Female Circumcision is a form Female genital mutilation • In practice since time immemorial.
- 44. Indications
- 45. Indications • Religious, cultural, hygienic . • phimosis, • paraphimosis, • balanitis • Posthitis • children who require clean, intermittent catheterization to facilitate this procedure.
- 47. Contraindications • Prematurity, • Anomalies of the penis – chordee, – hypospadias, – epispadias, – concealed or buried penis, – micropenis, – webbed penis, – ambiguous genitalia. – recurrent urinary tract infections • Bleeding diatheses are not absolute contraindications for circumcision
- 48. Indications: Benefits and drawbacks
- 49. Indications: Benefits and drawbacks • Protective against penile cancer. • The prepuce provides protection to the glans from dryness and keratinization.
- 50. Position
- 52. Anesthesia
- 53. Anesthesia • GA in children. • Penile block in adults.
- 54. Incision • Dorsal slit • Circumferential incision in both layers of prepuce about half cm distal to corona.
- 56. Operative findings • Confirm healthy glans.
- 57. Operative steps • Hemostasis. • Figure of eight suture at frenulum. • Seal with tincture benzoin.
- 59. Post op. Management • Nothing specific.
- 60. Prevention
- 61. Prevention • If the prepuce does not readily retract, parents should not attempt to clean under it • Inability to retract the foreskin during routine cleaning or bathing. Parents may also be alarmed by "ballooning" of the prepuce during urination — a normal finding
- 62. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
- 65. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage
Editor's Notes
- drpradeeppande@gmail.com 7697305442
- drpradeeppande@gmail.com 7697305442
- drpradeeppande@gmail.com 7697305442