Phimosis and Paraphimosis Surgery Presentation.pptx

Lecture on Phimosis

1. PHIMOSIS

2. INTRODUCTION Inability of the prepuce ( fore skin )to be retracted behind the glans penis in uncircumcised males
After a few months , adhesions dissolves & the foreskin becomes retractable.
If it does not, the infant has phimosis
It can be associated with balanitis xerotica obliterans.

3. TYPES OF PHIMOSIS PHYSIOLOGICAL
Occurs naturally in new born
formation of the prepuce is completed by 16 weeks gestation
epithelium separates via desquamation
PATHOLOGICAL
inability to retract the foreskin
Chronic balanoposthitis fibrotic ring of tissue
balanitis xerotica obliterans ( BXO)

4. EPIDEMIOLOGY 4% of new – borns have retractable foreskin
by the age of 3 , 90% of the prepuce are retractable
Remaining 10% ,will have physiologic phimosis
1% of 16 year old will have non – retractable foreskins
46.5% of adult circumcision was attributed to phimosis

5. DIAGNOSTIC TESTS BLOOD AND URINE TEST
to measure the blood sugar levels in the body.
May be a risk factor for type 2 diabetes mellitus PENILE SWAB TEST to check the foreskin for bacteria
URINALYSIS to check for urinary track infection

6. CLINICAL PRESENTATION HISTORY
> AGE
>SYMPTOMS
Ballooning of foreskin during voiding
Penile pain
Dysuria
Urinary Infection
PHYSICAL EXAMINATION
> INSPECTION
redness
Purulent
scarring of the foreskin
> PALAPATION tenderness
> Retraction of the foreskin not possible

7. GRADING OF PHIMOSIS Grade I. – Fully retractable prepuce with stenotic ring in the shaft.
Grade II – Partial retractability with partial exposure of the glans
Grade III – Partial retractibility with exposure of the meatus only.
Grade IV – Partial retractability with neither the meatus or glans is exposed
Grade V – No retractability

8. MANAGEMENT Reassurance and Vigilance
Proper preputial care and hygiene
Topical Steroids
0.05% Betamethasone bid for 4-6 weeks.
Dilatation and stretching SURGICAL Conservative Surgical Alternative
Conventional Male Circumcision

9. MANAGEMENT Conservative Surgical Alternatives :PREPUTIOPLASTY Preservative of the foreskin, erogenous, and sexual physiological functions
Disadvantage : recurrence Other methods : Meatoplasty and Frenuloctomy

10. TYPES OF CIRCUMCISION Using surgical devices Gomco Clamp Mogen Clamp Plastibell Dorsal Slit / Free – hand Excision
Sleeve resection

11. CIRCUMCISION INDICATIONS. Religious, cultural, hygienic
phimosis Paraphimosis balanitis Posthitis

12. CONTRAINDICATIONS Hypospadias Epispadias Chordee Penile webbing
Buried penis Ambiguos genitalia
megalourethra

13. BENEFITS Reduce penile cancer
Reduce UTI occurence rate
Reduce STI transmission rates
Reduce cervical cancer rate in female partner