PHIMOSIS

What’s it?

The penis is composed by root, body and glans. The body of the penis is the hanging part of the organ having in its extremity the glans.

The body of the penis contains the two chambers of the corpora cavernosa and the corpus spongiosum that surrounds the urethra. The corpora cavernosa and the corpus spongiosum are erectile tissues.

In the penis extremity, the corpus spongiosum dilates, forming the glans in which the final extremity of the urethra and the urethral meatus (urethral orifice) are found.

The skin envelops the penis, and approaching the glans it detaches off and advances over the glans, constituting the prepuce. The prepuce is retractile, that is, it exposes the glans when pulled back. The inability of exposing the glans when the prepuce is drawn back is called phimosis.

Phimosis is physiological (normal) in newborns due to the natural adherence between the prepuce and the glans. With the growth of the penis occurs the natural separation of the prepuce from the glans.

This process is aided by erections that occasionally occur in older children. At age 3, 90% of the prepuce can be retracted, and fewer than 1% of men have phimosis at seventeen.

How is it treated?

The separation of the glans from the prepuce must occur naturally.

Attempts at forcing the prepuce in the separation may lead to minor local injuries with scar tissue formation. This removes the elasticity from the prepuce, causing aggravation of phimosis or formation of secondary phimosis.

In older children (4-5 years old) in whom phimosis may be causing hygiene problems, resulting in balanoposthitis (inflammation of the glans and prepuce), creams with corticoids can be applied in order to facilitate pulling the prepuce back.

In cases resistant to creams, surgical treatment is indicated.

In many cases the prepuce is overly tight on the glans, interfering with the urine jet. A sort of “balloon” forms on the tip of the penis, originated by the prepuce dilated by urination. The obstruction formed may lead to local infection as well as urinary infection. Surgery – circumcision – must be considered in these cases.

Circumcision

Circumcision, also called postectomy, is the removal of the prepuce that surrounds the glans, leaving it exposed. It’s a routine procedure for some religions (Jews and Moslems).

The indication of circumcision in newborns aiming at the prevention of cancer, sexually transmitted diseases, urinary infection and balanoposthitis is a controversial issue.

In the event of penile cancer, it was found that 2% of men with penile carcinoma had been circumcised at birth.

However, it is known today that the presence of the prepuce is not the origin of neoplasia, but, rather, the genital hygiene habits of the individuals.

In 1989, the American Academy of Pediatrics concluded that:

“…Circumcision in newborns poses potential medical benefits with advantages, but also with shortcomings and risks.”

These conclusions have recently been corroborated. Additionally, each case must be individualized, and a discussion with the parents should be undertaken.

Circumcision presents a mean of 1.5 to 5% of complications such as:
 

bleeding
infection
stricture of the urethral meatus
excessive or insufficient removal of the prepuce
prepuce asymmetry

Severe penile lesions by the electrocautery have also been reported.

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