A phimosis is a constrictive change in the skin of the foreskin that prevents exposure of the glans. There are degrees of this constrictive ring and it should not necessarily be a postectomy or circumcision (circumcision).
The patient with exuberant foreskin is not an indication of postectomy. If it is possible to expose the glans easily, surgery is contraindicated. It is rarely indicated for aesthetic reasons or for a foul smell caused by bacterial proliferation.
A preputial skin covers the glans. It aims at its protection and contains large amount of sebaceous and sweat glands. In its external phase there is skin and in its internal mucosal phase, therefore more vulnerable to bacterial or traumatic aggressions. The function of these glands is to make the glans and foreskin wetter. Like this, the glans is prepared for penetration into sexual intercourse. There is increased secretion with sexual arousal.
In addition, balano-preputial secretions protect the urethra from contamination. Thus, it prevents bacterial ascension. It can cause urinary tract infection: urethra, bladder, ureter and kidneys. Beyond of the genitals, prostate, deferent, seminal vesicles, epididymis and testes.
In this microenvironment there is its own bacterial flora, microelements and antibodies that protect the glans from external aggression.
In the crown of the glans, there are the Tyson glands with spiculate aspects that are mucus producing and responsible for sebaceous lubrication. Therefore, the foreskin has physiological importance.
The presence of the glans has a protective function for the urinary and reproductive system. We can say that God did not create the glans by chance. There is, in fact, a peculiar anatomy of physiological importance.
Phimosis surgery, when well indicated should be performed.
Many microorganisms may be the main agents of local infections. However, sometimes it is caused by a mixed flora. In some children younger than 2 years may be the cause of lower urinary tract (ITU). In this way, postectomy is indicated.
Stagnant urine in the foreskin can promote bacterial proliferation. Some cases that are not operated at the right time can by repetition infections evolve with adhesions. Initially faint, but can evolve to firm adhesions between the glans and the foreskin. Permanent deformations and difficult solutions can occur.
Another complication of glans exposure is the development of narrowing of the urethral meatus. This can even cause obstruction to the urinary stream. This can cause bladder damage and even cause kidney failure.
The staged smegma in a patient with phimosis is one of the cofactors involved in the etiopathogenesis of penis cancer. Diabetic patients should be operated on as they are more vulnerable to urinary tract infection.
Doctors should advise the uncircumcised and homosexual to perform the circumcision. Surgery can reduce the risk of contracting HIV and various sexually transmitted diseases (STD), according to the proposed guidelines of the Centers for Disease Control and Prevention (CDC). In these patients, resection of the foreskin should be recommended.
The agency based its proposed recommendations on clinical trials in Africa between 2005 and 2010. The circumcision reduced the risk of HIV infection in 50% to 60% . In addition, the risk of contracting herpes simplex virus type 2 and human papilloma virus types decreased 30%.
That said, when there is indication of surgery, it should be performed. The purpose of this surgery is to resect the constrictor ring, without leaving the glans exposed. The foreskin is most likely to cover the glans partially, at least half of the glans. Thus, with this aspect, surgery is considered perfect.
O foreskin has a physiological protective role for the glans. An exposed glans modifies completely, leaving the glans completely altered. Over time, there is a change in the mucosa to the epithelial covering, a process called metaplasia. This is not at all healthy and I explain why.
Keratinization of the skin covers the sensitive cells of the glandular mucosa. This prevents sensitivity in sexual intercourse. In this way, the sensation of pleasure diminishes. The glans is a region of the richest receptors in the body. When the foreskin is removed completely, the glans loses its luster. There is a decrease and / or obstruction of the glandular ducts that produce the secretions. So it gets dry.
The surgery is done using quality suture yarns and fine, full resorption. In this way, there is a good cosmetic and functional result. The preputial mucosa should remain intact, maintaining local moisture. Therefore, it is essential for homeostasis of the local microenvironment. A glans is most responsible for local sensitivity.
The glans exposed after a postectomy should receive dermatological care. However, its functional recovery is impossible. Therefore, it is necessary to use moisturizers to improve the mucosa, thus minimizing the metaplasia.
In addition, during surgery, brake removal, frenuloplasty? This is an issue that I will comment on in another chapter, so special when the very postectomy (postectomy).
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