Surgery for phimosis in children and adults

The operation for phimosis is carried out quite often, and does not belong to the category of complex operations. Consider the features of this operation.

Is it possible to do surgery for phimosis?

Often patients ask whether to do surgery for phimosis. So, it is indicated if a boy or a man has a narrowing of the foreskin, which is of a pronounced pathological nature. In this case, exposure of the glans penis is impossible. Exposure of the penis can be painful. This condition leads to a violation of sexual life, negatively affects the processes of urination. In this condition, inflammatory and infectious processes often occur. [1]

Phimosis is a pathology that requires surgical treatment. Phimosis as a natural physiological condition is possible if the child is a newborn, or is at an early age. After the child has reached puberty, this phenomenon becomes a pathology. It is also worth noting that phimosis is a pathological phenomenon against the background of cicatricial and inflammatory processes.

Indications for the procedure

The operation should be carried out if there are indications for it. The main indication is the development of phimosis in adult men and sexually mature boys. At the same time, pathological immobility of the foreskin is characteristic, in which the opening of the penis and the release of its head is impossible. If there is pain, swelling, redness, inflammation, discomfort, the operation is also performed. In the presence of any complications of the disease, pathology, the operation is performed at any age. With relapses of inflammatory processes, complications, with inflammatory lesions of the prepuce and glans penis, surgery may be indicated on an emergency basis. Also, the following diseases are noted as indications: balanitis, alanoposthitis, condylomatosis, the presence of any neoplasms, foreign bodies, infections under the foreskin.

Surgery for cicatricial phimosis

With cicatricial phimosis, surgery is indicated. Its duration is approximately 30-40 minutes. It takes approximately 14 days for the body to fully recover. The advantages are that the rehabilitation period is short, after 2 weeks patients can return to their usual way of life (you can carry out any hygiene manipulations, return to intimate life, urination is restored without pain). As a rule, patients report that after the operation, the discomfort is much less pronounced than the daily difficulties associated with phimosis.

Cicatricial phimosis is one of the forms of pathological narrowing of the foreskin, in which a scar occurs. Cicatricial phimosis is considered as an acquired, irreversible condition resulting from trauma or mechanical damage to the foreskin. As a result of damage, a scar occurs, which is, in essence, a scar that occurs at the site of damage to the skin. With this form of phimosis, surgery is the only possible treatment. The foreskin is circumcised. This is due to the fact that phimosis cannot disappear on its own, it is constantly progressing. There is a further narrowing of the skin, in connection with which there are more and more incisions, cracks, breaks. Accordingly, new scars are formed. The faster the operation is performed, the more effective it will be, the sooner further recovery will come. [2]

Circumcision is an elective outpatient surgical procedure. A convenient time is chosen, the time of the operation is scheduled, then it is necessary to take preparatory measures, in particular, tests for infections. They also take standard tests, such as a blood test, a urine test. The operation is carried out mainly in the morning, always on an empty stomach. You can not eat 4-5 hours before the procedure. Local anesthesia is applied. In this case, the sensitivity disappears, it returns 2-3 hours after the operation. The recovery period does not exceed 14 days.

Preparation

Preparation for the operation is standard. It includes a set of necessary examinations, including blood tests, urine tests, ECG, fluorography, bacteriological studies, tests for infections. At the same time, the features of preparation are determined by the age of the patient and other features, individual physiological indicators of the patient. Consultations of specialists are definitely needed, and you also need to get a conclusion from a pediatrician or therapist, which will indicate whether the patient can have an operation. When planning general anesthesia, it is imperative to consult with an anesthesiologist to select the optimal method of anesthesia. As a rule, the allergist finds out the allergic anamnesis, draws conclusions about which type of anesthesia the patient needs. The anesthetist needs a complete medical history. It is necessary to say about the presence of concomitant diseases, the presence of genetic or congenital anomalies, as well as the medications taken.

If the operation is allowed, in about 2-3 weeks you need to switch to a balanced diet. At the same time, all fatty, fried, smoked foods should be excluded from the diet. Also, you can not use marinades, spices, spices. Confectionery should also be excluded. Alcohol for 14 days also needs to be completely excluded, the intake of anticoagulants and other medicines is canceled. A few days before the operation, you need a light meal. Also on the day of the operation you can not eat or drink anything. On the day of surgery, thoroughly wash the genitals with water and a mild soapy lather. In the pubic and groin area, hair must be removed. In this case, you need to carry out the shaving procedure very carefully, so that there are no cuts. If the operation is performed on an adult, he does it at home on his own. If the procedure is performed on a child, all the necessary preparatory measures are performed by medical personnel. If the operation is performed on a newborn or a young child, you should not forget to take with you all the necessary hygiene items, diapers, wipes.

Before admission to the hospital, all necessary documents are drawn up, a written consent to the procedure is signed. Then a preoperative consultation with an anesthesiologist is carried out, after which a consent is signed for the selected type of anesthesia. As a rule, consultations of doctors, solving organizational and documentary issues, takes about 2-3 hours. Therefore, you need to arrive at the department a few hours before the scheduled time of the operation. It should also be taken into account that on the day of the operation, the patient will most likely not be discharged home, although there are such cases. As a rule, the patient is under observation for about a day. You also need to take into account the fact that for several days the patient will not be able to drive a car, not so much because of an operating injury, but after anesthesia and sedatives have been administered.

Anesthesia

The operation requires anesthesia. So, anesthesia is mandatory, but the method of its implementation is determined by the doctor. Local or general anesthesia may be given. The choice of method depends on the age of the patient, on the condition, severity, volume and duration of the surgical intervention. Everything also depends on the characteristics of the psycho-emotional state of the patient. During the circumcision procedure, newborn boys are shown local anesthesia. However, the patient must be securely and firmly fixed, motionless. However, due to the high activity and mobility of children at this age, this method is unsafe, so most surgeons still use mask anesthesia. In this case, the child lies calmly, and the surgeon carefully, slowly performs all the necessary manipulations.

For older children, general anesthesia is always used. This avoids injury to surrounding tissues, and also prevents the risk of psychological trauma in the child. As a rule, the operation with local anesthesia is painless. However, if the operation proceeds without anesthesia, the child observes everything that happens, resulting in psychological trauma. Anesthesia allows you to avoid severe stress in the child.

Older patients have every right to choose the form of the operation. For adult men, both general and local anesthesia can be used. In any case, men experience stress and psychological discomfort to a much lesser extent if the operation takes place under general anesthesia. It is also much easier for the surgeon to carry out the necessary manipulations if the patient is under general anesthesia. This eliminates the possibility of spontaneous movements. Also, general anesthesia is indicated if the patient is overexcited, if he has fear, or panic, doubts. In the event that a person has allergies and individual intolerance to drugs or anesthesia, it is better to limit yourself to local anesthesia.

Technique of the surgery for phimosis

Consider the technique of the operation for phimosis. So, the patient must be laid on the operating table on his back, legs should be spread apart. After the anesthesia has fully worked, the surgeon proceeds to carry out all the necessary manipulations. If anesthesia is carried out with the help of an anesthetic gel, it must be applied in advance. Then, immediately before the operation, the skin is treated with special antiseptic agents. For processing, as a rule, iodonate is used. In this case, not only the penis is subjected to treatment, but also the abdomen, the area of the scrotum, thighs and buttocks. After antiseptic treatment, it is imperative to cover the patient's body with sterile underwear. The whole body is closed, only the place where the manipulation will be carried out opens.

The opening of the foreskin is narrowed, so it needs to be expanded. This is done with clamps. The skin is pulled back, the head is exposed. If there are adhesions on the genitals, they must be separated. The doctor makes markings with a scalpel (the line along which the incision will go is indicated). After that, the surgeon proceeds directly to the incisions.

One of the techniques for performing circumcision is the circumcision technique (circumcision). During the operation, several techniques are used: dorsal incision, operation using a clamp, circular resection.

A dorsal incision is performed for phimosis and paraphimosis. This procedure has a number of advantages, in particular, it can be carried out independently, without assistants. Go through the operation in several stages. First you need to apply clamps to the foreskin, then the skin is cut (around 12 hours). The skin is cut off along the intended line, after which suturing takes place. Be sure to coagulate the vessels, then a sterile dressing is applied to the wound. [3]

The simplest technique for performing the operation is the operation with the use of a clamp. The presence of an assistant is required. The disadvantages of the method include the fact that for some time after the operation there will be no attractive aesthetic appearance. The essence of the procedure is that the skin is captured with clamps, then it is pulled to the required length. Then the skin is cut off, after cutting off the skin is retracted and fixed with sutures. After the procedure, a sterile dressing is applied.

Of particular interest is the technique of circular resection. This is, in fact, a cosmetic procedure that is performed with an assistant. It is indicated for developed and pronounced saphenous veins. This approach dramatically reduces the risk of bleeding. During this procedure, the surgeon marks the incision line, makes the necessary incisions, and separates the skin flap from the glans penis. Then the skin is excised, a sterile bandage is applied. [4]

An alternative method is the method of surgical treatment - preputioplasty. It is used in cases where the cicatricial change affects only the tip of the foreskin. The duration of the procedure is approximately 20 minutes. The consequences and complications are much less, the pain is also expressed rather weakly, it is easily quenched with the help of conventional painkillers.

The procedure is carried out in several stages. First, a small incision is made in the prepuce along the course of the penis. The incision should be large enough to open the glans penis. Also, during the incision, the doctor dissects fibrous skin adhesions. After performing all the necessary manipulations, the doctor applies sutures, a sterile bandage.

Meatoplasty is also performed. This is a method of surgical intervention in which the narrowing of the outlet is corrected. As a rule, during this procedure, the doctor performs an additional biopsy, conducts an endoscopic examination of the urethra. [5]

Operation types

With pathological phimosis, surgery is always performed, since this is the only possible treatment. As statistics show, among all men of puberty who underwent such an operation, about a quarter of them were carried out precisely in connection with pathological phimosis. With phimosis, several types of operations are possible. The choice of one or another type of operation depends on the age of the patient, his type, severity and severity of the pathological process, as well as on the skills and qualifications of the doctor himself.

The main types of operations currently practiced are: circumcision, or circumcision, preputioplasty, meatoplasty. A traditional surgical operation is also performed, which is performed using a conventional surgical scalpel. The modern method of treatment is laser radiation. Traditional surgical treatment is often performed because it is the cheapest and easiest way. This method does not require special equipment, and can be performed in a conventional operating room, in a conventional surgical department. A number of urologists can perform this operation. But it has a number of disadvantages, in particular, after the procedure, a long rehabilitation period is required, the risk of complications increases sharply. The patient must comply with numerous medical recommendations, in particular, the patient is limited in his abilities for several months, in particular, sexual life is limited. The procedure is accompanied by suturing, in their place, scars and scars can remain for a long period of time.

Endoscopic treatment of phimosis is performed on an outpatient basis. Hospitalization is required for 1-2 days in the normal course of the postoperative period. As a rule, the patient comes in the morning, he is operated on, after which he spends several hours or days under the supervision of a doctor. If everything is normal, the patient can leave the hospital. As a rule, the operation lasts 30 minutes. [6]

Phimosis laser surgery

Currently, laser phimosis surgery is increasingly being performed. This procedure uses a laser instead of a traditional scalpel and scissors. A special laser beam is used. Under the influence of this flow, tissue is heated. When this evaporates water, cells are destroyed. The laser acts like a cutting tool. In general, the technique for performing the procedure is similar to that of the traditional surgical technique.

The advantage of this technology is that there are significantly fewer complications with laser exposure. In particular, there are no complications such as infection, bleeding. Significantly less pain. It is worth noting the high accuracy of the procedure. The rehabilitation period is much shorter, and is approximately 3-4 days. The duration of the intervention is much less - up to half an hour. [7]

Contraindications to the procedure

As contraindications to the operation include severe decompensated pathology of the internal organs until the disease stabilizes. The operation is not performed in case of acute infectious and inflammatory processes, hemostasis disorders, blood clotting disorders, when taking anticoagulants. Also, it is not necessary to perform an operation in the presence of pustular infections, with ulcerative lesions of internal organs, in the presence of pus and exudate in the prepuce. However, this contraindication is temporary. When the state stabilizes, the operation is carried out mono. Also among the temporary contraindications include structural changes in the penis. In this case, plastic surgery is required first, and only then an operation is possible. If a man has venereal infections, diseases of the genitourinary system (infectious, inflammatory), the operation is also not performed. First, a full recovery is required.

Consequences after the procedure

After the operation, in the first days there is a feeling of discomfort, pain. But these sensations usually disappear within a few days. It is also worth noting that the pain is quite easily stopped with the help of conventional painkillers. After the operation, it is extremely important to observe the correct rehabilitation period, the duration of which ranges from several weeks to several days, depending on the severity of the condition, the chosen surgical technique. It is important to ensure proper skin care, hygiene of the genitals. In this case, you need to use sterile dressings (dry, clean). It is better not to take a shower for a while, or to put on a condom while taking a shower. Showering is not recommended for children. For them, ordinary rubdowns are quite enough. They must be carried out in such a way as not to wet the bandage.

It should also be borne in mind that men can experience spontaneous nocturnal erections, which cause pain and discomfort. It can also lead to blood flow disorders. Sometimes, with a strong erection, a divergence of the seams is possible, but this is extremely rare. With a pronounced violation of blood flow, the bandage should be removed for a while. As a rule, in this case, the penis will be swollen, somewhat enlarged. But this should not be cause for concern, as this is a normal reaction to tissue damage. Usually, the removal of sutures is not required, since self-absorbable sutures are used during the operation. You do not need to remove them, except for those cases if they have not resolved within 10 days.

Care after the procedure

After the procedure, special care and rehabilitation is required. The patient is transferred to the postoperative ward, where he spends several hours. In the absence of complaints and complications, the patient is discharged. In the normal course of the postoperative period, the patient is allowed to go home. If there is a risk of complications, the patient will not be discharged. Operative treatment of phimosis is considered to be less traumatic. The patient's activity is sharply limited, but this is only for a few days. In general, the rehabilitation period does not exceed 1-2 weeks. For the first time, bed rest will be required for 2-3 days. This reduces the swelling of the genital organs. In order to fix the penis, you need to wear sweaty tight-fitting underwear. It is necessary to wear a special bandage (bandage). In the first few days, wearing it is mandatory, since it provides protection for the penis from excessive loads and pollution. It also prevents the development of edema. The dressing should be applied in such a way that the urethra is not closed and does not interfere with urination. After a few days, the bandage is removed. It can be removed by a doctor, or by the patient himself. If the bandage sticks, it must be carefully treated with chlorhexidine, and removed after it is soaked. It is impossible to remove the bandage by force, as this can lead to damage to the mucous membrane, resulting in complications and adverse consequences. If you have had an  operation for phimosis, hospitalization is not required, but rehabilitation must be strictly observed.