Phimosis surgery when it is indicated, the method of handling, processing,

Surgery indicated for phimosis pathological form of a narrowing of the foreskin, after exposure of the glans impossible, too painful and in breach of the sex, often cause inflammatory processes. The most common treatment can be considered, information which is currently carried out, not only in the traditional way, has been known since ancient times, but with the help of modern technology, and laser surgery.

the operation for phimosis

Phimosis is a pathological when the foreskin is able to move to a full exemption from the payment of the skin of the glans of the penis. As a physiological phenomenon, which is typical for the newborn period and early childhood, and become pathological in adults, men and teenagers, at puberty, including on the basis of the scarring and inflammatory changes.

A variety of measures and methods to relieve the pain

Surgical treatment when the disease is phimosis is just a drastic measure to get rid of the pathology. According to the statistics, about one-quarter of adult men have been trimming for a reason. In this disease there are many different types of operations, the choice of which is determined by the old-age period of time, the nature and severity of the disease, medical training and equipment, and that it works.

In our day to day practice:

  • For information;
  • praeputium;
  • Meatoplasty.

The treatment may be carried out traditionally, i.e. with the use of a scalpel, a modern way of laser. Traditional therapy is available, and relatively inexpensive, and can be done in any hospital where the urologist, but it does have limitations:

  1. The long recovery is due to a major injury;
  2. The greater the risk of complications;
  3. The need for a time limit of sexual life,
  4. The risk of scarring in the place of suturing.

Indications and contra-indications for surgery

The indication for surgical treatment, to be regarded as pathological phimosis in boys and adult males, all of the complicated forms of the disease in patients of all ages, and relapses inflammation of the foreskin and the glans of the penis condylomatous, foreign bodies under the foreskin.

Among the obstacles:

  • In severe decompensated pathology of the internal organs to the stabilization of the disease;
  • An acute infection;
  • Pathology of hemostasis;
  • Ulcerative skin lesions in the area of the foreskin (temporary contraindication);
  • The structural changes of the penis (Hypo - and epispadias) — required plastic;
  • An infection of the urinary tract and genital organs (acute or chronic repeat) — medicine.

Preparation for the operation of the

Before the planned surgical treatment of phimosis of the child, or an adult who has been assigned a list of required tests — a blood test, urine sample, EKG, chest x-rays, and the study of infections, etc., depending on the age of the. You may end up at a place of stay in the clinic. The compulsory detention of the therapist or the pediatrician about the absence of common contraindications. In the planning of General anesthesia, the patient will consult another, and the anesthesiologist, which is revealed by the presence of an allergy, experience with anesthesia in the past, the names of the products.

phimosis operation

2 weeks prior to the start of the treatment is cancelled the funds to make the blood more fluid. The house in the morning to the intervention need to carefully wash the genitals with warm water and a mild soap, for adults, for men, the hair of the pubic area and groin are removed independently at home, avoiding the breaks in the skin, or in the hospital, the parents of the children to the clinic for diapers, wipes and other necessary baby toiletries. If a planned intervention under General anesthesia for 8 hours before and the next morning before the surgery is not able to eat or drink.

At the reception, you will need the proper documents, sign a written consent (the patient or the parents of the boy to speak again with the urologist and anesthesiologist, which may take 2 to 3 hours, so it's better to get there in advance. The work of the patients-both men need to lighten up the day to day work, as well as, to quickly perform the procedure, immediately "run" the operation is unlikely to be successful.

Adult men are informed of the fact that after the removal of the phimosis you will not be able to drive it, not only because of the surgical trauma, but also even to a larger extent, mainly due to the introduction of the tranquilizers, or drugs for anesthesia. In this connection, you need to consider in advance how it's going to come to the house.

The technique of the operation

During the procedure, the patient lies on his back with his legs parted. The surgeon proceeds to the operations at the onset of total anesthesia. In the case of a local anaesthetic gel that is applied in the forward and in the blockade of nerve roots at first limited to the operating area, the skin is prepared with antiseptic, and then the nerve to the injected anesthetic.

Regardless of the chosen technique for the removal of the phimosis, the operation area is treated with iodine, and the surgeon is not limited to the penis — it is necessary and in the stomach, and the skin of the scrotum and the thighs. After that, the patient is holding the sterile linen, you can't just close the site, which will be hosted by the manipulation of the.

To expand the narrowed openings of the foreskin, the surgeon takes the pictures. After that, take the skin of the back of the exposure head, and in the presence of the adhesions — they need to be separated. If you plan to crop according to these measures, a professional of the presents line, which will continue to work with the scalpel.

Crop

One of the most ancient and widespread of the measures that are used in the treatment and prevention of phimosis, and religious reasons, the circumcision. Developed many of the techniques of management, however, is the choice still remains with the surgeon, who assessed the clinical status and to the technical possibilities of treatment.

Types of pruning:

  1. A method, dorsal slit;
  2. The operation of the use of the clamp;
  3. The resection.

The indications for the use of a dorsal slit, are phimosis and paraphimosis. The advantages of this surgery are the possibility of carrying out alone without the second operation, and a low risk of complications, but there is a serious drawback: the surgeon must be experienced and have the necessary skills in this type of operation.

The dorsal slit technique involves several steps:

  • An overlay of the images on the foreskin;
  • Dissection of the skin, on probation for 12 hours;
  • The leather trim on the marked line, it can cause damage.

During the handling of the vessels, which were combined and then place on a wound a sterile dressing applied.

The use of the frame, it is considered a technically simple way, which does not require the presence of a second surgeon, however, has the disadvantage, however, is considered to be likely, an unsatisfactory aesthetic result of a few of the time for it.

With the use of the clamp, the surgeon first grasps the skin with the clips, then drag it to the desired cutting length. Then, directly to the clamp removes the foreskin and cuts it off close to the head of the penis. After clipping, the skin is put back and secured with a suture. In the conclusion of a careful hemostasis a sterile bandage.

The resection technique is very accurate, but it requires a very good command of the box, its features, and the presence of an assistant. This is to be used in the development of the subcutaneous veins, as it provides a lower risk of bleeding.

With a circular resection of the first, the surgeon marks the incision lines on the edge of the head, and at the point of attachment of the foreskin, and then make a cut along the lines of the skin flap, separating it from the penis. After the removal of the skin suture, which unites the vessels, the wound is covered with sterile cloth.

the types of operations and indications

Newborns and infants in the first few years of life, surgeons strive, to be used in the non-traumatic varieties, with the use of a special tray.

The clip is made of plastic the device is for single use, which is reminiscent of the bell. This technique is attractive, because it is not needed, it can be easily damaged. During the surgery, the urologist makes a vertical incision from the free edge of the skin in the direction of the root of the penis is mental for 12 hours, then put on his head and placed the clip is covered with leather, fixed by a thread. The excess foreskin is cut off, and the handle of a "bell" is. After about a week the rubber ring itself to go away.

The clips are designed for many applications, but their use of the pathological form of the disease is very limited. Today, specialists-urologists resort to them less often. The children in the use of these clips, and the seams don't overlap at all, and for the adults, as a result of the potential to get an erection necessary the edges of the wound to close it.

praeputium

Trimming an alternative method of surgical treatment of phimosis is considered the praeputium, which is to be limited to cases of cicatricial changes have touched only the top of foreskin. This is an operation for phimosis outpatient basis, and takes approximately 20 minutes, and produces less impact-and less-pronounced pain.

A contraindication to plastic surgery in the prepuce may become an excessive contraction, and are, in so far as such application may trigger a relapse of the disease.

The technique of praeputium involves a number of sequential steps:

  1. the behaviour of a small longitudinal cut of the foreskin towards the root of the penis, the extent of the cut provided free of charge, of the exposure of the head of the skin at the time of its backward movement;
  2. in the case of the scarring of the phimosis, the surgeon, in parallel with the skin incision dissecting fibrous adhesions;
  3. suturing of the skin, that provide exposure to the head.

Meatoplasty

Meatoplasty is a method of surgical correction of the narrowing of the orifice of the urethra. It serves as a complement to the other cases, if the phimosis is a narrowing of the urethra, and in its final part. This is what happens in cases of severe phimosis as a result of obliterating balanite.

After Meatoplasty box gives a cystoscopy to examine the urethra endoscopically and removed the stenosis in the other areas. If it is determined that a patient will need a surgery to extend the urethra – stenting.

Treatment for phimosis laser

In the last few years, medicine widely used for the laser, and urology is no exception. The technology of laser removal of phimosis includes application of a laser instead of a scalpel, and a pair of scissors. The luminous flux which causes heating of the tissue, the evaporation of the water, and the destruction of the cells, it acts as a cutting tool. The mode of operation is similar to that in the conventional crop.

Laser circumcision has a number of significant advantages:

  • Give fewer complications (infection, bleeding);
  • The pain is less pronounced;
  • It has a high accuracy;
  • The rehabilitation period is short (3-4 days vs a week and a half (in normal operation);
  • The shorter the duration of the intervention (for up to half an hour).

The experts say that it is a laser treatment to prevent damage to the vessel, with a lot of bleeding, as it is a ray of light heats up and seals in their walls, so this method is selected, the pathology of clotting in a patient, or high risk of bleeding. By the way, was first used in Israel for the treatment of a boy with hemophilia.

The disadvantages of laser therapy are considered to be of low availability, due to the high cost of the equipment, you are able to afford one clinic, it is a must have for professionals who understand the technique of laser treatment of the phimosis, as well as the high cost of the operation to the patient.

After the surgery

Once the operation has been completed, it is managed by the transportyou to the recovery room to stay, where to spend a couple of hours, in the absence of any complaints or signs of problems. If all goes well, you will go home the same day. In the opposite case, the hospital will have to stay.

the use of the images

Operative treatment of phimosis is not considered to be traumatic, and are not intended to limit the activities of patients, however, a specialists-urologists, we recommend that for the first couple of days of lying in bed: lying down reduces the swelling of the genital area. The shot of the penis will have to wear tight underwear.

Regardless of the technique, each procedure involves the wearing of a bandage (the bandage). There is a need in the first few days to protect the penis from dirt and also to prevent strong swelling of the. The bandage is applied, so that the opening of the urethra not being closed, and the condition of urination.

A few days later, the bandage can be removed by a physician or by the patient (parents). If you had the time to dry and adhere to the skin must be moistened with an antiseptic (chlorhexidine, for example), and then carefully separate. Careless, and the forced removal of the dressing can cause damage to the mucous membranes of the body, and complications.

The bandage is removed a few days later on. The Penis will be swollen and somewhat enlarged, it would not have been the cause of the fear. Swelling may last a week or so, and then it will gradually go away. Surgeons usually use, again, it is not necessary to remove it, as it is to solve it yourself, but if you can't solve it in 10. a day in the period of recovery, they need to be removed at the doctor's.

The regular stitches after an operation to remove at the end of the week or a bit later. Its better if you remove them the surgeon who performed the surgery. He will continue to be controlled by the process of regeneration.

The effect of the treatment can be assessed, not at the same time, it is because you have to rather a long period of time — sometimes for up to six months. At this time, the potential complications — abscess, hemorrhage with bruising, pain during erections, a serious scar tissue at the seam.

25.07.2019