Why Choose Cedars-Sinai Marina del Rey Hospital for Phimosis Treatment?
The highly-skilled, well-trained urologists at Cedars-Sinai Marina del Rey Hospital evaluate patients with phimosis and advise an individualized treatment plan. There are several conservative and surgical treatment approaches to treat phimosis. The treatment is chosen based on the severity of the condition.
Phimosis is a condition that may be present at birth (physiologic phimosis) or acquired later in life (pathologic phimosis) and is characterized by an inability to retract the prepuce (foreskin) over the head of the penis. Physiologic phimosis is seen in most newborn males and during the early years of life because of natural adhesion between the foreskin and the glans penis. This adhesion eventually dissolves as erections happen and physiologic phimosis resolves as age advances. In about 90% of boys, the foreskin can be retracted by the age of 3. It is considered abnormal when the inability to retract the foreskin persists through late adolescence and early adulthood.
Pathologic phimosis is associated with the scarring of the foreskin which leads to an inability to retract it. Retraction of the foreskin forcefully can lead to microtears that can cause scarring and phimosis. This condition may be the result of poor hygiene and recurrent balanoposthitis (infection of the glans and foreskin), balanitis (infection of the foreskin), malignancy, and diabetes mellitus. Patients with a pathologic phimosis often suffer from painful erection, recurrent urinary tract infections, hematuria, preputial pain, and a weak urinary stream.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Phimosis
Surgical treatment is considered in recalcitrant cases of phimosis that does not respond well to conservative measures of treatment. The technique used to treat phimosis is called circumcision and there are different techniques to perform this procedure. Either complete (radical) or incomplete (foreskin sparing) circumcision may be undertaken. The three methods of circumcision include the Plastibell device, the Mogen clamp, and the Gomco clamp method. These devices are used to stop blood circulation to the foreskin during its resection. The entire procedure may last for about 15-30 minutes.
Drugs and Other Treatment Needed for Phimosis
| Medications |
Topical steroid creams such as Betamethasone 0.05% are prescribed to treat symptoms of phimosis. Application of this steroid 1-2 times a day for about 6-12 weeks has been used to heal phimosis. Topical antibiotic and antifungal cream may be prescribed if there is a presence of balanitis or balanoposthitis. |
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| Dilation and Stretching |
Dilation and stretching aim to release the foreskin adhesions and involves foreskin retractions that are gently done by the doctor on an outpatient basis. An eutectic mixture of local anesthetics (EMLA) may be used during the procedure. |
| Congenital/Physiologic Phimosis |
This type of phimosis is asymptomatic and does not raise any concern. Often noted with this type of phimosis is ballooning of the foreskin while urinating. |
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| Pathologic Phimosis |
This type of phimosis is rare but affects both boys and men. The symptoms include irritation of the skin, difficult urination, bleeding, and sometimes urinary retention. There is scarring of the preputial ring. The severity of phimosis is graded as follows:
Men with this type of phimosis often complain of pain or discomfort during sexual intercourse and while retracting the foreskin. In elderly men, severe phimosis causes swelling and cracked fissures over the foreskin. This type of phimosis is usually associated with inadequate hygiene and conditions such as diabetes mellitus. |
Symptoms of Phimosis
Although phimosis is commonly asymptomatic, it may give rise to problems when symptoms occur. These include:
- the presence of swelling, redness, or soreness of the foreskin
- the ballooning appearance of the foreskin while passing urine
- not being able to retract the foreskin even after the age of 3
- a discharge under the foreskin
Diagnosis of Phimosis
The diagnosis of phimosis is primarily made on the basis of medical history and physical examination alone and does not require laboratory tests or imaging tests if there are no signs of urinary tract infection.
Risk Factors for Phimosis
Physiologic phimosis is a common occurrence in newborn infants and persists until the age of 3. There are certain risk factors that may lead to the development of pathologic phimosis, which include:
- Attempts to retract the foreskin in infants: this causes infection, microtears, bleeding and secondary scarring leading to pathologic phimosis.
- Inadequate hygiene: failure to maintain good hygiene leads to recurring infections of the glans penis (balanitis) and foreskin inflammation (posthitis) that causes pathologic phimosis.
- Conditions such as diabetes mellitus: diabetes is associated with higher glucose level in the urine which promotes the proliferation of bacteria and resultant infections.
- Repetitive use of catheter: this is also a risk factor that increases a man's chance of developing phimosis.
- Advanced age: older men are at higher risk of developing phimosis as a result of infrequent erections and loss of elasticity of the skin.
Causes of Phimosis
The etiology of phimosis is attributed to the following factors:
- Natural adhesions between the prepuce (foreskin) and the glans penis (physiologic phimosis): during the developmental stages, the inner lining of the foreskin remains attached to the glans through adhesions. With penile growth and intermittent erections during the early years, the foreskin gradually separates from the glans.
- Foreskin scarring: Recurrent infection of the glans (balanitis), urinary tract infections due to inadequate hygiene can cause scarring and narrowing of the foreskin, which in turn predisposes to infections. Diabetes mellitus may also increase a person’s risk of developing infections. This is because the residual urine trapped under the foreskin of a diabetic patient may lead to enhanced bacterial proliferation due to glucose content in the urine.
- Trauma to the foreskin or rough forceful retractions of the foreskin.
Alternative medicine is helpful to treat symptoms of phimosis but only during the initial stages. Herbs such as Calendula and Chamomile have been used to stretch the foreskin. These herbs are prepared in the form of hot water baths. Chamomile is an anti-inflammatory agent that is helpful in healing microtears. Barley also helps reduce itching and relieves pain.
Physiologic phimosis is a natural phenomenon and will be present at birth. It is not preventable; however, the acquired form of phimosis or pathologic phimosis can be prevented by maintaining good personal hygiene. It is essential to clean the area underneath the foreskin regularly during the bath to prevent infections and subsequent phimosis.
Are you suffering from phimosis? For any questions, information, or guidance regarding the treatment of phimosis, get in touch with our specialty-trained, skilled urologists at Cedars-Sinai Marina del Rey Hospital.