F I M O S E - More frequent questions

What is PHIMOSIS?

Phimosis is the difficulty, or even the impossibility of exposing the glans (head " of the penises) because the foreskin (it " skins " that recovers the glans, the head of the penises) has a very narrow ring. It is not the simple fact of the foreskin (it skins) to be glued in the glans (head), what is frequent and normal in the first years of life (to the 6 months only 20% of the boys get to expose the glans totally, but 90% almost get already it to the 3 years).

Why do the children have PHIMOSIS?

The most common reason is the assaduras (dermatites amoniacais), causing postites, and heal (fibrose). As scars always retract the skin, this turns the ring more narrow prepucial. Children's cases also exist in that the parents worried with the normal acolamento between the glans and the foreskin make "massage", forcing the skin, and causing small traumatismos (microtraumatismos), that to the they heal they turn the narrow ring, and there they form a true phimosis.

Should not he make "exercises or massages" then to help "to open" the ring of the skin (foreskin)?

No, because they can happen microtraumatismos with pain, local inflammation and even sangramentos, and the cicatrization can take to a narrowing of the opening in the foreskin. The exercises to the they cause pain and desconforto they also create in the child the fear that somebody moves in its genital. This fear interferes in the hygiene peniana, and when not taking place a good hygiene they happen the postites (inflammations or infeções of the foreskin), that are other cau-healthy of phimosis. This fear also hinders the acceptance of the surgery, of the postoperative cares, and it interferes in the acceptance of its sexuality.

How to prevent Phimosis?
	The best prevention is to teach to the parents as they accomplish the hygiene perineal, without they make " massages and exercises ", and recognizing and treating the dermatites amoniacais appropriately (assaduras) and the postites.

Why do the children with Phimosis need surgical treatment?

a) to allow the adapted hygiene of the penises.
b) to allow in the future a satisfactory sexual relationship.
c) to avoid or to correct PARAFIMOSE (when the hole of opening of the foreskin, for being a lot of estrei-to, is soon arrested below the glans, with pain, immediate swelling and difficulty of urinating
d) to decrease the balano-postites risk (infections of the foreskin and glans), urinary infections, venereal diseases and of the cancer in the penises.
e) to decrease the cancer risk of I glue of uterus in its future wife.
It is dear that more than 18% of the not circumcised boys can develop surgical indications until the 8 years of age.
Observation: Phimosis doesn't impede, nor it harms the growth of the penises, therefore the surgery (he/she Postecto-meows) it won't help the growth of the same.

Which the ideal age for surgery of Phimosis?

In the non complicated cases it is awaited until about of the 7 - 10 years of age, for 3 reasons:
a) In this period it can happen the normal descolamento of the foreskin, the cure, not needing the surgery more.
b) it is the end of the period in which the child accomplishes its identification sexual, called Phallus Phase, for-so much the boy already understands the need of the surgery, and the risk doesn't run of thinking a piece of its penises was cut (Syndrome of the Castration)
c) before entering in the school (1st degree), when they happen the frequent comparisons in this age group they turn the postoperative more painful, and they increase the risk of the complications.

How can the parents prepare its son for the surgery?

In first place the parents should receive from the surgeon pediatric orientations that you/they allow them conhe-cer as the surgery will be accomplished, so that they feel safe and they can transmit this safety for its son.
Besides it is important not to hide of the patient that it will be accomplished, but without entering in details that he cannot understand and that cannot you scare him. Former.: the word " to cut "
To demonstrate love, safety, and you take it possible, if, to know the place where the surgery will be accomplished it also aids in I prepare it pré-operative.

How is it made the surgery?

Unless the patient has other diseases or that the parents prefer, the surgery will be made of National health clinic, this means that the patient doesn't need to be interned, she won't sleep, to pass the night in a room of the hospital, avoiding like this a larger separation of the family atmosphere, and decreasing the risks of infection hospitalar.
As the surgical technique, and the as of skin to be very dry (retreat), this varies according to the patient's age, the intensity of the fimose, and the surgeon's experience.

Can the parents attend the surgery?

In the children above 6 to 12 months of age is important that one of the relatives stays child close to until that she sleeps, so that she feels safe. In some hospitals of Porto Alegre it is allowed and incen-tivado the permanence of the mother's father e/ou beside the child during the anesthetic induction..
During the surgical act however it is not allowed, for not being necessary, to decrease the infection risk, and to avoid upset the routine of the surgical room.
In the Room of Powder-anesthetic Recovery, the parents can stay beside the son, tranquilizing him, and aiding him feeding after being very awake.

And is the anesthesia, local or general?

In the childhood, and even in the adolescence, the general anesthesia is preferred, generally preceded by the use of a sedative, a sedative, because besides being now safe (inferior risk of complications to 1:5.000 anesthesias) also:
a) it Avoids that the patient attends and participate in the surgical act.
b) it Avoids the pain of those " pricked " of needle and of the local anesthetic's introduction.
c) it Allows the patient to stay quiet, without moving during the surgery.
d) THE patient won't remember anything that you/he/she happens in the surgery room, doesn't tend therefore any psychological trauma.

And after the surgery, how many days does the child need to lack the class?
	The boys, if possible, they are operated in one Thursday or Friday, and they come back the classes peacefully in for 2a. fair, but with the recommendation that avoid physical exercises for 2 weeks.

DR. LIONEL LEITZKE e-mail: lionel@uroped.com.br
Main Office: rua Mostardeiro 157 - conj. 406
90430-001 - Porto Alegre - RS - Brasil
phone: (0xx51) 3222-4227 - fax: (0xx51) 3346-2907
General Pediatric Surgeon and Pediatric Urologist