PHYMOSIS (phimosis; Greek phimosis short circuit, closing of an opening) — the pathological narrowing of an opening of a prepuce which is not allowing to bare a balanus.
T. can be inborn and acquired. At inborn F. the inner surface of a prepuce is connected to a balanus — a so-called physiological phymosis. However true F. in these cases is not present, the opening of a prepuce is easy rastyazhimo, and its «pasting» with a head is caused by yet not come division of these two surfaces. Independent separation of a prepuce from a balanus at the child occurs gradually owing to erections and rejection of an epithelium of both skin surfaces and comes to an end on average by 4 years. Stagnation of contents of the formed cavity and its infection can lead to a balanoposthitis (see the Balanitis, a balanoposthitis), to-ry causes cicatricial changes of a prepuce and true F. The so-called inborn phymosis at adults in many cases is acquired owing to the balanoposthitis postponed in the childhood.
Acquired F. the hl develops. obr. because of inflammatory diseases of a penis, most often — a balanoposthitis, and also an injury of a penis. Inflammatory process leads to cicatricial narrowing of an outside ring of a prepuce.
T. can be temporary, reversible or alternating owing to a recurrence of an inflammation (a tran-zitorny phymosis).
In a form of a prepuce distinguish hypertrophic and atrophic F. At hypertrophic F. the prepuce is narrow, has an appearance of the proboscis which is hanging down from a balanus (fig. 1); meets at inborn F more often. At atrophic F. the prepuce narrow and short, fits a head tightly, leaving seen only its top with an outside opening of an urethra; meets at adults more often. Stagnation of preputial contents at F. under a narrow prepuce leads to development of an infection, accumulation of a large number of a smegma (see), sometimes to formation of peculiar stones — smegmolit. In the conditions of the broken emptying of a preputial cavity inflammatory process in it proceeds very persistently and the cicatricial changes of a prepuce developing on ego_ to the soil, in turn, aggravate F. Long stagnation and decomposition of a smegma at F. promote emergence and development of tumors of a penis (see the Penis, tumors).
At sharply expressed F. the urination occurs with natuzhiva-niy, a squirt. At patients with hypertrophic F. at the moment to urine -
Fig. 1. A penis at a phymosis (a hypertrophic form): at the left — to an urination; on the right — zo time of an urination.
Fig. 2. Separation of a prepuce from roj are dexterous a penis at a phymosis at children by means of the metal probe.
emissions spherical inflation of the hobotkoobrazny extended prepuce (fig. 1) can be observed. Except complaints to impossibility of opening of a balanus, adult patients note also pains during an erection (see). Long difficulty of an urination at F. leads to disorder of urodynamic (see), to development of pyelonephritis (see). At a full cicatricial obliteration of a prepuce there can come the acute delay of an urination. Difficulty of an urination at F. can also lead to formation of hernias of a stomach, a prolapse of the rectum that is connected with increase in intra belly pressure at a natuzhivaniye. To complications F. carry also a paraphimosis (see).
FINANCIAL LEU 327
Diagnosis F. usually does not raise doubts; it is based on characteristic complaints of the patient and typical changes of a type of a penis. The differential diagnosis is carried out with a banal balanoposthitis, syphilis (see), cancer and other diseases of a penis (see).
Treatment of a physiological phymosis conservative. If to 4-year age there is no spontaneous disclosure of a preputial cavity, a balanus try to exempt from a prepuce, carefully delaying it a hand towards a root of a penis. Thanks to elasticity and distensibility of «proboscis» of a prepuce this manipulation in some cases is successful. However it is necessary to use the metal probe more often, roundabouts to-rogo a prepuce separate from a balanus (fig. 2). After that the preputial cavity is cleared of a smegma, oiled sterile liquid and again pull a prepuce over a balanus in order to avoid a paraphimosis. Further recommend to parents of the child regularly (1 — 2 time a week) to bare a balanus for carrying out a gigabyte. actions that at the same time is prevention F. and its complications.
At true F. both at children, and at adults make circular circumcision (circumcisio). Operation is shown at complicated and uncomplicated F. in order to avoid the related complications. At children it is carried out under anesthetic (with - m), at adults — under local anesthesia (see Anesthesia local). After an applying a tourniquet on a root of a penis the prepuce is cut longwise between two clips (fig. 3, a), without reaching 0,5 — 1 cm a pozadivenechny furrow. Then continue a section cross, parallel to a wreath of a balanus (fig. 3, b); at the same time leave a border of an internal leaf edge -
Fig. 3. Diagrammatic representation of operation of circular circumcision:
and — the prepuce is delayed and is cut between two clips; — circular circumcision at the basis; in — suture on edges of a wound with capture of outside and internal leaves of a prepuce; — a type of a penis after unwinding (the gauze bandage fixed to a wound by the ends of sutural ligatures is applied the line of seams).
to it fleshes 0,5 cm wide', along a bridle of a prepuce expand a border in the form of a wedge-shaped ledge not to damage the vessels passing here. Outside and internal leaves of a prepuce sew nodal or continuous catgut seams (fig. 3, c). Apply a bandage in the form of the gauze roller the line of seams, to-ry fix to a wound the ends of the imposed ligatures (fig. 3, d). At detection on skin of the opened balanus patol. changes the urgent biopsy is necessary. The remote prepuce is subject obligatory gistol. to a research.
In the postoperative period the patient of teenage age is also more senior appoint sedative drugs for the prevention of a possible erection. To avoid wetting of a bandage urine, to the patient recommend to use the wide tube which is densely put to a balanus at an urination.
The forecast in case of early and radical elimination F. favorable. In the subsequent recommend overseeing by skin of a balanus and prepuce for the purpose of early detection of precursory symptoms of possible tumoral process.
Prevention F. the hl consists. obr. in observance a gigabyte. actions. At adults the major role in prevention F. plays early detection and treatment of inflammatory processes of a penis.
Bibliography: To e f e r N, And. About anemic treatment of an inborn phymosis, It is new. hir. arkh., t. 19, book 2, page 197, 1929; H about-p and to E. The long-term results of operational treatment of a phymosis by a method Ga-sinsky, Urology, No. 2, page 60, 1962;
Shab d A. L. Tumors of a penis, Alma-Ata, 1967; G an i of d n e r D. Fate of foreskin» study of circumcision, Brit. med. J., v. 2, p. 1433, 1949; About x e-n i u s K. Uber Phimosenbehandiung, Kinderarztl. Prax., Bd 18, S. 8, 1950.
A. L. Shabad.