Treatment of Phimosis in Paris & Neuilly

Dr Adam Vardi - Urologist

Narrowness of the preputial ring

Treatment of phimosis in Paris

Phimosis is defined as a narrowing of the preputial ring (the tip of the foreskin) which prevents total or partial uncovering of the glans. While this condition is physiological in young children, it may become pathological in adolescence or adulthood. Management by the urological surgeon is based on a precise assessment of tissue suppleness and functional consequences for voiding or sexual life.

Dr. Adam Vardi guides patients through the diagnosis of phimosis and offers graduated solutions, ranging from conservative medical treatments to corrective surgery.

Understanding phimosis: from physiological to pathological

Urological Surgery in Paris & Neuilly

At birth, the foreskin is naturally adherent to the glans. This protection is normal and disappears progressively with growth. Phimosis is considered pathological if it persists beyond the age of 3 or 4, or if it appears as a scar phimosis in adulthood.

Congenital phimosis

This is the most common form in children. The opening of the foreskin is simply too narrow to allow the glans to pass. In most cases, there is no pain, but discomfort may appear during voiding if the orifice is punctate (very tight).

Acquired or scar phimosis

In adults, phimosis is often the consequence of chronic inflammation (balanoposthitis). The skin loses its elasticity and turns into fibrous, rigid tissue. A frequent cause of acquired phimosis is lichen sclerosis et atrophicus, a dermatological condition that creates a whitish, sclerotic ring around the preputial orifice. Diabetes is also a major risk factor, favoring repeated infections that result in retractile scarring of the foreskin.

Complications associated with phimosis

Doctor Adam Vardi

Untreated phimosis may lead to several medical complications, sometimes requiring urgent intervention:

Paraphimosis: This is the classic urological emergency related to the foreskin. It occurs when a narrow foreskin is forcibly retracted behind the glans and can no longer be replaced. The ring then constricts the glans like a tourniquet, blocking venous return and causing massive oedema. If the foreskin cannot be replaced manually, intervention is required to release the strangulation.
Balanitis and balanoposthitis: The inability to retract the foreskin prevents proper hygiene of the groove beneath the glans. The accumulation of smegma may favor the proliferation of bacteria or fungi, leading to painful infections, discharge, and redness.
Sexual dysfunction: In adults, phimosis may make sexual intercourse painful (dyspareunia) due to excessive tension on the preputial ring during erection. It may also cause skin tears or bleeding at the frenulum.
Tumor risk: In the very long term, chronic inflammation related to tight phimosis is a recognized risk factor for the development of penile cancer.

Management of phimosis

Urologist in Paris

Diagnosis and therapeutic options

Diagnosis is exclusively clinical. During the consultation, the urologist assesses the degree of retractability and the condition of the skin (suppleness or presence of sclerosis).

Medical (topical) treatment

In children and in some mild forms in adults, a conservative approach is attempted as first-line treatment. It consists of applying a potent corticosteroid ointment for 4 to 6 weeks. This treatment aims to thin the skin and make it more elastic, allowing gradual and gentle retraction maneuvers.

Preputioplasty

This is a conservative surgical option consisting of small incisions in the preputial ring to widen its opening diameter while preserving the foreskin. This technique is of interest to patients who wish to avoid circumcision, but it carries a higher risk of recurrence, especially if the tissues are very scarred.

Posthectomy (Medical circumcision)

Posthectomy is the definitive treatment for phimosis. It involves the surgical removal of the foreskin.

Indications: Cicatricial phimosis, failure of medical treatment, lichen sclerosus, recurrent paraphimosis.
Procedure: The procedure takes about 30 minutes and is typically performed under local anesthesia in adults and short general anesthesia in children. The sutures are absorbable.
Benefits: Permanent elimination of the risk of infection and paraphimosis, and improved local hygiene.

Postoperative Follow-Up and Recovery

The postoperative care following phimosis surgery is straightforward but requires strict hygiene:

Healing: This takes about 2 to 3 weeks. Swelling and bruising are normal during the first few days.
Care: Clean the area with soapy water and apply healing ointments or petroleum jelly to prevent the scar from sticking to underwear.
Recovery: In adults, complete sexual abstinence for 4 weeks is essential to prevent the scar from tearing during erections. In children, it is recommended to avoid sports activities for 10 to 15 days.

Conclusion

Phimosis is a benign condition, but its consequences can significantly impact quality of life and urogenital health. A pragmatic management approach, tailored to the patient’s age and the severity of the narrowing, can restore long-term comfort during urination and sexual activity. Dr. Vardi prioritizes providing clear information about the various options so that the treatment choice is understood and accepted by the patient or his parents.