Phimosis is not a disease. It is just an overgrowth of prepucial skin, which is Present over the glans of the penis. It is very common in the population of India. Many children with paediatric OPD are diagnosed every day with congenital phimosis by a paediatrician. It is so common that nobody gives attention to the overgrowth of this skin. Many times parent took his child to a general practitioner who may not be aware of the treatment for phimosis. Hence such patients become neglected for many years and when they develop some complications like urinary infection and inability to pass micturition, recurrent fever, then only they are advised to approach a surgeon for circumcision.
Hence in this article, I want to tell you why should wait for surgery when you know from day one that you are a child have phimosis which requires only the proper type of surgery and not some misbelief.
What is phimosis
When a baby is born, a paediatrician always checks the opening of the penis whether it is sufficient to pass urine or not and also check whether a nice is well you love or not. Although on day 1 it is not possible to predict whether bye baby has phimosis or not but within a month are two months it can be clear if the baby has difficulty in passing urine. In many countries, circumcision become their religious procedure. Hence they routinely circumcise the foreskin of a baby in the early days of life. You can say within the sixth month of baby.
This happens in developed countries where a baby is always born in a hospital and doctor advised them circumcision within a few months and parents returned to the hospital for circumcision after few days. This is a sophisticated procedure and it is considered minor surgery.
But in developing countries, circumcision is done by their religious leader without hospitalization and without anaesthesia too. The complications of the procedures are enormous but as the procedure is free of cost and under the banner of custom, parents always bear the pain of infection and complication. They never complain against their leader.
How to how to diagnose phimosis.
After immediate birth of the baby, when the baby micturates and cry, that could be the first sign of phimosis. if the baby can pass urine without crying then the baby may not have phimosis. At this stage, we cannot check the preputial opening efficiently because at birth it always seems narrow. When boys develop up to 6 months, it becomes evident whether the baby has sufficient opening or not. If you cannot check the opening of prepuce then consult a paediatrician who can check babies opening.
On the other hand, while micturition if you see the ballooning of foreskin then it could be phimosis. If the patient is crying while micturition, then it could be phimosis.
In this way, you can check your baby whether he has phimosis or not. Sometimes you may miss the diagnosis or many parents never give attention to the penile structure or the penis while passing urine. But if your child is getting fever every month without any cold and cough then you must think of urinary infection which could be because of phimosis. Every parent must keep in mind that the baby could have a urine infection due to phimosis.
With this information in mind, you can always check your baby if he has a recurrent bout of fever.
what are the customary practices for phimosis?
There are many customary practices for the treatment of phimosis are present in every country. In India also in many homes the prepuce of the baby is forcibly retracted and lubricated with oil and cover back. With this lubrication, they think that the opening will enlarge sufficiently when the baby will grow up. I don’t know the effect of these practices on whether it leads to sufficient dilatation of prepuce or not. But it may lead to more tight phimosis. As retraction is very forceful, it causes multiple erosions over the prepuce. These multiple erosions Heal by fibrosis and lead to a more tight narrow preputial opening. Hence the result of this practice is doubtful whether to do it or not. As a doctor, I could not tolerate the practice of this type and never support such practices.
Another practice is advice by general practitioners all over India is the application of some steroid cream with retraction. This also leads to forcible retraction of the prepuce with the application of steroid cream. When your baby penile opening is very small, you cannot retract it and with force, it causes very pain to the baby and lead to the formation of erosions. As said earlier such erosions lead to tight phimosis. Hence this practice also is not recommendable.
If the parent does not practice any manual dilatation of foreskin opening then his general practitioner may be involved in some practices like dilatation of prepucial opening with surgical forceps. He used to take one artery forceps and without giving any type of anaesthesia to the baby, goes on dilating his prepucial opening with the artery forceps. This leads to Intense pain and erosions around all preputial skin. Temporally the result is good, which means it looks good for parents that the opening has enlarged sufficiently but later it again leads to tight phimosis. So I request parents not to allow such dilatation in any clinic by a doctor. On the other hand, such a type of dilatation is not a treatment for phimosis and it is going to create more tight phimosis. Hence be aware of such miss-practices.
What to do to in phimosis
The latest treatment is only a surgical treatment which can be best practised at the hospital only.
If you want to cut the prepuce of your baby by surgical way, you must go to the hospital and get it done by General Surgeon.
Many people around you will force you to get treatment from the local doctor who seems to be an expert in circumcision surgery. These so-called doctors are not a doctor and never get any type of training in circumcision surgery but bye by working with some another quack doctors who also used to do such type of surgery, these doctors get self Trained and start circumcision surgery as a specialist in the community.
Hence at the hands of the quacks, if you give the penis of your baby there are more chances to get it to infect, to get it bleed tremendously and may lead to some fatal complications. As educated and caring parents, you must not listen to your surrounding people and your close friends who often forces you to get it done right at your home by some quack doctors without any type of medicine and hospitalization.
You think that your baby is very precious for you and how you can allow any untrained doctor to touch him without any proper knowledge. Such awareness is needed to develop among the people of India, then such practices will not exist in the coming years. But it is our bad luck that although we are techno-savvy, we people are number one all over the world having the cellular phone in each hand, we are lagging behind healthcare sector due to such practices.
Because people don’t want to spend much on health issues even though their child safety is most important.
How does phimosis get operated on?
The first step is to consult the specialist doctor who is a General Surgeon by profession. He will check the penis of your baby and also will check testicular development and will suggest whether the baby needs circumcision surgery or not. If he finds the prepucial opening is correct in order then he can request you to get done ultrasonography. On ultrasonography, you may come to know that your baby has a urinary tract infection. By doing ultrasonography it became clear that because of forceful micturition through a small opening kidney of the baby has not compromised due to backpressure changes. So it become mandatory to get ultrasonography done before surgery for phimosis. Then the doctor will explain to you the type of anaesthesia required for the baby. It is General anaesthesia because local or spinal anaesthesia will not be suitable for this age group. Your baby needs to be nil by mouth for at least 3 hours then he can be taken to the operation theatre. So generally this surgery is planned in the morning time so that baby could not wait with an empty stomach for a long time. You will get admitted in the morning. You will be strictly warned that you should not feed your baby after awakening in the morning. You come to the hospital directly from your home without feeding him or in sleeping mode also. In the hospital, the baby will be canulise and taken to the operation theatre under sedation. In the operation theatre, he will get general anaesthesia and preputial skin will be cut. There are so many types of operation for circumcision but it is not possible to enumerate all these in this article. But some important operations which we do practice in India are given below.
Types of circumcision surgery
There are many types of surgery practised all over the world. The reason behind the development of these surgeries is that no one is perfect with respect to time required, healing of the wound, need of anaesthesia and multiple other factors. But some of them are commonly practised which I am going to enlist here.
Open surgical method
Zsr stapler method
Plastibell method
Gomco bell method
Zhenxi rings method
Smartklamp method
These are the methods which are more practised all over world and India too.
But you should not confuse which method to be used. In my thinking, all methods are good and cut your foreskin for circumcision. Only the difference in its surgery, post-op care and need of the type of anaesthesia. Ultimately the doctor best decides which surgery will be best for you or your baby. It is also the choice of a surgeon who is best practising and well trained in the type of procedure. Hence leave it to the doctor to decide the procedure.
Also, read about Adult circumcision