Treatment of phimosis and synechia

What is phimosis and synechia?

Phimosis is a narrowing of the foreskin of the penis, as a result of difficulty or the inability to expose the glans penis.
Synechia is the tight attachment of the foreskin to the glans penis, which eliminates the displacement of the foreskin to expose the glans penis. For synechia, narrowing of the foreskin is not characteristic.
Synechiae are considered the norm up to 3-4 years. If there is no concomitant inflammation and narrowing of the foreskin, then synechia is the norm in 6-8 years.

Symptoms of phimosis and synechia

The impossibility of exposing the foreskin (prepuce) accompanies both states.
The synechia of the foreskin creates an enclosed space in which smegma accumulates. - The usual discharge of white color with a yellowish tint, consists of fat and protein, and, accordingly, is a breeding ground for microorganisms. Non-compliance with hygiene leads to infection and suppuration of smegma and the occurrence of inflammation of the foreskin and glans penis.
The narrowing of the foreskin is preceded by its repeated inflammation against the background of impaired hygiene of boys. With significant narrowing, it may be difficult to urinate and maintain hygiene.
Sometimes smegma under thin skin prepuce looks like a neoplasm, causing anxiety in parents.
If the appearance, condition, smell of discharge or foreskin provokes warnings, you should consult a doctor (pediatrician / family doctor or pediatric surgeon / pediatric urologist).

Reasons, risk factors

Inadequate hygiene is the cause of inflammation of the foreskin.
There are many prejudices about this. If the girls are more or less, then in the field of boy hygiene there are strange recommendations. And it spreads both by doctors and parents. Parents often do not conduct proper hygiene of the external genital organs of their son. Sometimes doctors advise "do not touch at all, do not look in, wash from above, and only ...". This creates ideal conditions for the reproduction of bacteria under the foreskin. There is redness, swelling, pain, especially when urinating, itching. Against the background of such inflammation, a rough separation of the synechiae easily leads to trauma to the foreskin. Torn wounds scarring roughly - this speeds up the narrowing.
In a clean, within the reasonable, there is no inflammation and itching.
It is important to have the correct hygiene products (liquid soap or gel for intimate hygiene). And not more than 1 time per day, and until the end of life ...
There are several mechanisms for the independent separation of the foreskin from the head:

• erection before urination;
• accumulation of smegma under the prepuce and "hydraulic" disconnection of the prepuce from the glans penis
• "Workout with gradual detachment" of the foreskin from the head during hygiene of the external genitalia.

Treatment

The main thing is prevention. As described above, synechiae generally do not require special interventions. Only with inflammation, and only under conditions of very gentle handling of inflammatory tissues, is there evidence for separation of synechiae, often determinate after reduction of the inflammation itself.

The situation is more complicated with phimosis

If the cicatricial process in the foreskin has not gone too far, turning to the doctor there is hope for conservative treatment, that is, without surgery. With inefficiency, only surgical treatment remains.
If, when trying to expose the glans penis, it is not possible to see at least the urethral opening, or when urinating, the foreskin is inflated with a ball and urine is excreted in drops - the process is started. And most likely, partial or complete circumcision of prepuce - circumcision will be necessary.
It is no secret that circumcision is also performed from religious traditions.
Before the planned operation, the child must be healthy in general, i.e. 10-14 days without general weakness, fever, impaired nasal breathing and nasal discharge, cough, nausea, vomiting, diarrhea.

And also pass the necessary tests, 10 days are valid:

1. general blood test with leukocyte formula and platelet count;
2. coagulation time and duration of bleeding
3. blood glucose
4. general urine analysis
5. blood type, Rh factor (if known, bring a document - an extract from the hospital, a child’s development card, birth certificate - to clarify)
6. ECG.

Complications

In advanced cases of phimosis, a threat also arises from the side of the kidneys, up to the expansion of the prefabricated system of the kidneys - hydronephrosis. And usually, a complication is repeated inflammation and paraphimosis.
Paraphimosis is a condition where the area of ​​narrowing of the foreskin with careless or gross exposure of the glans penis moves actually below the head. There is pinching, which disrupts the blood supply to the head and its death is possible. This is an emergency condition that requires consultation and intervention by a pediatric surgeon or urologist.
When entering phimosis into adulthood, the threat of insolvency or significant difficulties during it.

When do I need emergency care?

With paraphimosis, an urgent consultation with a pediatric surgeon or pediatric urologist is necessary. You need to call 103 and find out about the next hospital with a pediatric surgeon or a pediatric urologist at the place of residence, and contact there as soon as possible.
With inflammation of the foreskin, phimosis, a planned consultation with a pediatric surgeon or pediatric urologist is necessary on the next working day.