Phimosis is when the hole at the tip of the foreskin (prepisium) that covers the pipi head is very narrow and cannot be pulled back. This is the case in newborn babies, and the head of the penis is not visible. Most of the phimosis are physiological, and some of them cause problems. In particular, it is necessary to distinguish this problematic part well.
In physiological ones, when the foreskin begins to recede, it creates a blooming flower scene. These children urinate very easily. If there is a pathological condition, there is a ballooning in the foreskin while urinating and the urine is dripping or thin. The hole at the tip of the foreskin is narrower than 0.5 cm. In these cases, circumcision should be done as soon as possible. If circumcision is delayed, undesirable conditions such as urinary tract infection, increased pressure in the bladder and kidneys - enlargement may develop. The necessity of early circumcision of physiological ones is controversial. In my practice, I recommend circumcision if the baby/child has a history of urinary tract infection. Creams containing steroids can be tried in children who do not want to be circumcised or who are inconvenient to be circumcised.
Sometimes we hear that it is recommended to pull back the foreskin at intervals and leave it in infants/children with physiological or pathological phimosis. This is very inconvenient and we never recommend it. The child suffers as much as he was circumcised, the skin adheres again, and because it is done without anesthetizing, the child is extremely afraid. At the same time, it can occur in a situation that requires emergency intervention, which we call paraphimosis.
Sometimes families; My child presents with complaints such as swelling on his penis, inflammation at the tip of his penis. Smegma deposits become yellow-colored swellings under the foreskin that can be easily seen from the outside, often worrying the family, and can be palpated. These are called foreskin pearls and there is no obligation to clean them. Over time, as the head of the penis and the foreskin separate from each other, they ejaculate. This event often leads the family to apply with the complaint of the discharge of inflammation from the penis of their child.
Paraphimosis is a condition that requires immediate intervention. It is the inability of the foreskin to return to its original state after the pipi is lowered from the head. The foreskin plays a role like a ring and fits tightly into the groove under the pipi head, causing no blood to flow to the pipi head. In the early period, the foreskin can be pulled back, but this possibility disappears as time passes. Pipi head begins to become edematous, pain occurs, and eventually its blood supply is impaired. Therefore, in cases where paraphimosis develops, the patient should be taken to the hospital or a doctor without wasting time. The treatment is to retract the foreskin back to its place under local or general anesthesia as soon as possible. Circumcision may be necessary if the paraphimosis does not improve.