Management and treatment of Phimosis

Management and treatment of phimosis should focus on the cause of the phimosis and also on how to prevent future episodes of phimosis. Patients who have phimosis very rarely need any emergency treatment. Urgent treatment is needed when the phimosis causes difficulty in urinating. Most cases of phimosis are completely resolved with treatment.

The following options are available for treatment of phimosis:

Non-surgical Treatment of phimosis:

phimosis-steroid-cream

Topical steroid is the first line of treatment

  • Application of a topical steroid
  • This is usually the first line of treatment. The topical steroidal ointment is applied to the penis twice a day for 4-6 weeks. Studies have shown a success rate of 70%-95% with this method. Although in the long term circumcision has proved to be more successful, the application of a topical steroid is a good alternative in some cases of phimosis. An example of a common steroid cream is betamethasone.
     
     

    phimosis-home-cure

    Phimosis home cure kit

  • Manual stretching
  • Manual stretching of the foreskin may be performed. This is achieved by slow and gentle stretching of the foreskin. It is not a good idea to perform this without medical guidance as it may lead to scarring which will worsen the phimosis. If this method is tried it should be guided and directed by a urologist or a trained medical professional.
     
     
     
     

  • Health education
  • Parents and caregivers should be educated that phimosis may be a normal part of development in boys up until adolescents and they should not force the foreskin back without consulting a medical practitioner. Forcing the foreskin back may cause the phimosis to worsen by causing scar tissue to form.

  • Urology referral
  • It is always good for the patient with phimosis to be examined by a specialist in urology. The specialist may then decide on the best treatment for each individual patient. This may include surgical and non-surgical options.

  • Antibiotics
  • If phimosis is present with an infection antibiotics will be prescribed to treat the infection. Broad spectrum antibiotics are usually used.

  • Analgesia and anti-inflammatory medication
  • Pain medication, also known as analgesia may be given for pain relief. Anti-inflammatory medication will help decrease inflammation.

Surgical management of phimosis:

surgical-treatment-phimosis

Surgical management of phimosis: Circumcision or Dorsal Slit procedure?

  • Circumcision
  • Not all cases of phimosis require circumcision. If the phimosis did not resolve with a topical steroid cream and other non-surgical methods, circumcision is usually the next option. A circumcision is a non-complicated procedure which is easily done on an out-patient basis which means that the patient does not need to spend the night in hospital. In adult males circumcision is performed using a local anaesthetic. In younger children general anaesthesia may be used if they are unable to lie still. The foreskin is surgically removed during this procedure. This is done using clamps and a scalpel. Any bleeding vessels are cauterized. The remaining skin is sutured together using dissolvable stitches. An antibacterial ointment is then applied with a bandage. The man is then advised to abstain from sex and masturbation for up to 6 weeks. If this advice is ignored the sutures might tear, the wound might become septic and the man puts himself at a greater risk of contracting additional infections.

  • Dorsal Slit procedure
  • A dorsal slit procedure may be performed as an alternative to circumcision. It is also known as a superincision and is done by a doctor who makes a single incision of the foreskin without removing any tissues. A dorsal slit procedure is less invasive than a circumcision. It is done when a circumcision is unpractical or undesirable. Most men rather opt to have a circumcision done because they prefer the look of the circumcised penis.

Phimosis is a relatively common condition. The difference between pathological and physiological phimosis should be made. Men with phimosis are encouraged to seek medical help especially if other complications are present. Phimosis usually resolves without any permanent complications.