The surgery indicated support only phimosis pathological forms of narrowing of the foreskin, if the exposure of the glans impossible, too painful, a violation of the sexual life, the frequent provocation of inflammatory processes. The most common treatment is considered to be the circumcision, which today is carried out not only in the traditional way, known since ancient times, but modern technology laser surgery.
With the support of only phimosis the abnormal, if the foreskin is not able to move to a full exemption, the skin of the glans of the penis. As a physiological phenomenon, it is characteristic of the newborn period or in early childhood also becomes abnormal, adults, men and teens, after puberty, including the background cicatrice, and inflammatory lesions.
Types of interventions methods of pain relief
Surgical treatment, when the disease with the support of just moses, not just the drastic measure to get rid of the pathology. According to the statistics, approximately a quarter of adult men have undergone circumcision for this reason. This disease there are several types of operations, the choice of which determined by age, period, type, and the severity of illness, medical training, operating equipment.
The day of practice:
- The circumcision;
The treatment can happen traditionally, i.e. with the help of a scalpel, a modern way of the laser. The conventional therapy available, relatively cheap and can be done in any hospital where a urologist, however, limitations:
- The long recovery is due to greater trauma;
- Higher the risk of complications;
- You need the deadline, the sexual life;
- The risk of scarring the place of suturing.
Indications and contraindications to the surgery
The indication for surgical treatment is considered abnormal support only phimosis in boys, adult men, all the complicated forms of the disease, patients of any age, but the relapses inflammation of the foreskin and the glans of the penis condylomatous, foreign objects in the foreskin.
Among the obstacles:
- Severe decompensated pathology of the internal organs, until the stabilization of the disease;
- Acute infection;
- Pathology of hemostasis;
- Ulcerative skin lesions in the area of the foreskin (temporary contraindication);
- Structural changes of the penis (Hypo-and epispadias) — required plastic;
- The urinary tract infection or genital organs (acute or chronic relapse) — to cure.
Preparation for the surgery
Before planned surgical treatment with the support of only phimosis child or adult will receive a list of all the necessary tests, blood tests, urine, ECG, chest x-rays, tests, infection, etc. depending on age. They can fill the place of residence at the clinic. Mandatory penalty a therapist, or pediatrician in the absence of common contraindications. When planning general anesthesia, the patient shall consult with the other and the anesthesiologist to find out the presence of allergies, experience with anesthesia in the past, name of the medication.
2 weeks of treatment lack of funds, which the blood more fluid. The house on the morning of the intervention need to carefully wash the genitals with warm water and mild soap, adult, male, hair, the pubic area, groin are removed independently at home, avoiding breaking the skin, or in the hospital, parents, children to the clinic for diapers, wipes and other necessary baby toiletries is also available. If the planned intervention under general anesthesia for 8 hours in the morning before the surgery, can't eat, drink.
The after login, you will need to sign the appropriate documents, signs, written consent (the patient or his parents) to again talk to the urologist and anesthesiologist, which may take 2-3 hours, so it is better if you arrive there in advance. Working with the patients-the men should be free that day from work, because even if quickly performed the procedure, immediately "run" the operation is not likely to succeed.
Adult male reported that after the removal of the support only phimosis will not be able to drive, not only due to the surgical trauma, but to an even greater degree due to the introduction of the sedatives or medications, anesthesia. In this context, it must be examined in advance how you will get home.
The technique of operations
During the procedure, the patient lies on the back with legs separated. The surgeon proceeds to the manipulations after the onset of total anesthesia. In the case of local anesthetic jelly is applied in advance, but the blockade of nerve roots at first, only the operational area of the skin is treated with antiseptic and a nerve injected anesthetics.
Regardless of the chosen technique to remove the support, just phimosis, the operation area is treated with iodine, the surgeon is not limited to penis — processing is required, or the stomach, and the skin of the scrotum, or the thighs. Subsequently, the patient shelter for sterile linen, so not only closed the place, which will host the manipulation.
Expand the narrowed opening of the foreskin, the surgeon takes clips. This came after the skin to the exposure head, in the presence of adhesions — they should be separated. If you plan to do the circumcision after these measures, the expert outlines the line, which will continue to operate with a scalpel.
One of the oldest and most widespread interventions, which is used for the treatment and prevention with the support of just phimosis or religious basis of circumcision. Developed many techniques, but the choice is always left to the surgeon, who reviews the clinical situation and the technical possibilities of treatment.
The type of circumcision:
- The method dorsal slit;
- Operation using a cuff;
- Circular resection.
The indications for the use of the dorsal gap in the support of only phimosis and para phimosis. Advantage of this surgery is the possibility of doing it alone, without a second surgery and low risk of complications, but it has a serious drawback: the surgeon should be experienced and have the appropriate expertise for such an operation.
The dorsal slit technique involves several steps:
- Overlay clips on the foreskin;
- Dissection, the skin on the conditional 12 hours;
- The leather trim on the marked line, network.
During the manipulation of the ship combined and laid on the wound with a sterile bandage should be applied.
Application the clip can be seen here technically simple method of operation, which do not require the presence of a second surgeon, however, the disadvantage is that it is considered likely unsatisfactory aesthetic results some time after the procedure.
In applying the forceps, the surgeon first grasps the skin clips, drag it to the desired cutting length. Then direct clamp captures the foreskin, and then cut close to the head of the penis. After cutting, the skin is given back, secure the stitches. The conclusion of a careful hemostasis a sterile bandage.
Circular resection technique is very accurate, but requires a good command of the surgeon, the features and the presence of an assistant. The development of the subcutaneous veins, as it provides a lower risk of bleeding.
The circular resection of the first, the surgeon marks incision lines on the edge of the head, and the point of attachment of the foreskin, then an incision along these lines the wattle, detached from the penis. After removal of the skin sutures, uniting the vessels, the wound is covered with sterile cloth.
Newborns and babies first year of life, surgeons strive to apply the non-traumatic varieties using special pliers.
The clip is a plastic device is disposable, which is similar to a bell. This technique is attractive because you don't have to sew. During the surgery, the urologist makes a vertical incision in the free edge of the skin in the direction of the root of the penis, the mental 12 hours, and then the head makes the clip, which is covered with a skin specified by thread. The excess foreskin is cut off, and the handle "bell". After a week the plastic ring to make it go away.
The clips are designed for several applications, but their use of the pathological form of the disease is very limited. Today the specialists-urologists use them less often. The kids, if you use these clips, the seams do not overlap, but adults, having regard to the possible erection necessary the edges of the wound to close.
Circumcision is an alternative method to the surgical treatment with the support of only phimosis can be considered praeputium, which is limited to cases where the cicatrice of changes only touched the tip of the foreskin. This operation is supported by only phimosis outpatient basis, takes about 20 minutes give, less consequences, and a less pronounced pain.
A contraindication to plastic surgery, the foreskin can become excessive contraction, fibrosis, when such an operation can trigger a relapse of the disease.
Technique praeputium a number of consecutive steps:
- perform a small longitudinal incision of the foreskin towards the root of the penis, the magnitude of the cut to ensure the free exposure of the head to the skin during the backward movement;
- in the case of a cicatrice of support just phimosis, the surgeon parallel to the skin incision dissecting fibrous connective tissue;
- suturing the skin, which is the exposure head.
Meatoplasty a method of surgical correction narrowing of the orifice of the urethra. It serves as a complement to other procedures, if the support of only a phimosis a narrowing of the urethra, the final part. This is what happens in the case of severe support only phimosis as a result of extermination of balanite.
When Meatoplasty surgery produces a cystoscopy to examine the urethra endoscopically, then removing the narrowing in other areas. If one is found, then the patient will need surgery to extend the urethra – stent implantation.
Treatment the laser support just phimosis
In recent years, medicine widely used in laser, and urology is no exception. Laser technology removal support just phimosis includes a laser instead of a scalpel, scissors. Luminous flux causing heating of the tissue, with the evaporation of the water, as well as destruction of the cells, acting like a tool. The technique, the operation is similar to the traditional circumcision.
Laser circumcision is a number of important benefits:
- Give fewer complications (infection, bleeding);
- The pain is less pronounced;
- This is great accuracy;
- The rehabilitation period is shorter (3-4 days vs a week and a half of normal operation);
- Shorter duration of the intervention (up to half an hour).
Experts say that laser treatment prevents the damage to the vessels severe bleeding, as the light heats and seals the walls, so this method is selected in the pathology of clotting in a patient or a high risk of bleeding. By the way, this was the first used in Israel in the treatment of boys in total.
Disadvantage of laser treatment is considered to be low availability due to high cost of equipment that you can afford to be a single clinic, the need for specialists who know the technique, the laser treatment with the support of just phimosis, as well as the high cost of the operation patients.
After the surgery
When the operation ended, the operated transportyou to the recovery room to stay, where to spend a few hours in the absence of symptoms or signs of complications. If all goes well, then go home the same day. Otherwise, to stay in hospital.
Operational management with the support of only phimosis is not considered traumatic, and does not limit the activity of the patients, but the experts-urologists still recommend that the first few days lying in bed: lying down, reduces the swelling of the genital organs. The capture of the penis need to wear tight underwear.
Regardless of the chosen technique, for each type of operation includes on knitting (knitting). He should be in the first few days to protect the penis from dirt and to prevent strong swelling. A bandage will be applied to the opening of the urethra is not closed, provided that urination.
A few days later, the bandage can be removed by the doctor or by the patient (parents). If you have had time to dry and adhere to the skin, should be wetted with disinfectant (chlorine, for example), and then carefully separated. Careless, violent elimination of dressings can cause damage to the mucous membrane of the body and the complications.
Remove the bandage a few days later. The penis will be swollen and slightly enlarged, not because of the fear. Swelling may last for a week, but then gradually went away. Surgeons usually use the threads that you don't need to be removed, as they resolve themselves, but if this is not resolved after the 10 day healing period, you need to remove the doctor.
Regular stitches after surgery at the end of the first week, or a little later. It is better if you remove them the surgeon who performed the procedure. You still control the process of regeneration.
The effect of the treatment can be evaluated not at the same time, because you need to restore a quite a long time — sometimes up to six months. At this time, possible complications — abscess, bleeding from the wound, pain during erection, severe scarring along the seam.