First of all, we have the anatomical characteristics of the foreskin: the skin structure of the foreskin is similar to the skin of the whole body, divided into epidermis and dermis. The epidermis is a complex flat epithelium with a keratinized layer. The dermis is irregular connective tissue, containing circular and longitudinal muscles to be elastic. There is no fat under the skin, only loose connective tissue connected to the deep fascia of the penis, which has significant stretchability and is adapted to stretching during erection. The foreskin skin contains a large number of various nerve endings, so it feels sensitive.
The foreskin of young children is generally long, the foreskin mouth is also small, wrapped around the entire head of the penis, under normal circumstances, with the growth of age, gradually upward retreat, foreskin mouth expansion, so the head of the penis exposed outside.
The penile blood vessels and lymph are very rich, and they all depend on the penis nutrition.
The nerves that govern the penis, there are somatic and vegetative nerves, parasympathetic foreskin in early childhood, the foreskin can protect the delicate glans, avoid friction and other injuries, and protect the urethral orifice to prevent and reduce the invasion of bacteria into the urethra. Premature circumcision is not conducive to genital development in children.
Find out what is circumcision, and circumcision?
The foreskin of young children is generally long. Within 3 years old, the inner plate layer of the foreskin and the urethral belt of the glans, the foreskin tissue is rough at different lengths, and the foreskin opening is small. As they grow older, the epithelial tissue is gradually absorbed, making the inner plate of the foreskin separate from the glans. And the head of the penis develops faster than the foreskin. It is only then that the penis regularly swells and erects, holding and expanding the outer foreskin opening, causing the foreskin to recede toward the coronal part of the head of the penis. As a result, the opening of the foreskin expands and the head of the penis is half or fully exposed. This is a normal development process, but if the penis mouth fails to expand enough, the outer urethral opening is sealed hole-like, the foreskin and glans are lax, or repeated circumcision makes the foreskin mouth thicken and narrow, can not turn the foreskin up, turn the glans can not be exposed, it is called prepuce. If only the foreskin is too long and can be turned up to reveal the coronal sulcus, it is called prepuce, which is a congenital deformity that is more common in clinical practice.
The etiology of prepuce and foreskin congenital factors (but whether it is related to genetics, is not clear) acquired factors on the basis of the circumcision, due to recurrent episodes of circumcision, the foreskin mouth slack formation foreskin tissue loss of elasticity, resulting in the foreskin can not be turned up and the formation of prepuce.
It is believed that zinc deficiency in children can also lead to circumcision secondary to circumcision, such as. Hidden penis, obesity, due to a large amount of fat at the root of the penis abnormal pile shape, so that the penis hidden in which it is difficult to enter the foreskin, the foreskin is empty symptoms, the occurrence of prepuce and prepuce.
Classification of prepuce and foreskin classification of prepuce 1, according to the penis and foreskin development status classification (1) atrophic prepuce: foreskin and glans are tightly adhered together, glans is stunted and deformed.
(2) Hypertrophic prepuce: thick and fat foreskin, too long, narrow foreskin opening, effortful urination, thin and bifurcated urine line.
2.Classification according to the situation of the outer foreskin (1) tubular prepuce: turn up the taut foreskin mouth, see the narrow section of the foreskin mouth is long, forming a 2-8mm tubular narrow section.
(2) Folded prepuce: that is, the foreskin mouth is folded and adhered, and cannot be turned up to reveal the urethral opening or glans.
(3) Simple circumcision stenosis, that is, the foreskin is not long, can road out of the urethral orifice a little, but can not be turned up 3, according to the classification of foreskin pathological changes (1) inflammatory adhesion prepuce: repeated infection of the foreskin, foreskin mouth adhesion narrow.
(2) scarring prepuce: repeated infection or trauma, causing scarring changes in the foreskin tissue.
(3) Comorbid prepuce: such as combined prepuce overgrowth, prepuce stone, prepuce cyst, leukoplakia, etc.
(4) Congenital prepuce and secondary prepuce: the latter is mostly due to repeated infection or trauma.
The pathology and clinical manifestations of prepuce and foreskin pathology congenital prepuce due to foreskin tightly wrapped penis head, penis head dysplasia, some may cause painful penile erection or sexual intercourse disorder. If the foreskin mouth is severely narrowed, or even pinhole-shaped, it may cause difficulty in urination, excessive pressure in the bladder, and urine reflux to the ureteral kidneys, which may lead to kidney damage in the long term .
Infection or trauma caused by secondary prepuce, so that the foreskin fibrous tissue proliferation, skin thickening, weakening or loss of elasticity, and serious fibrous adhesion of the foreskin and glans, foreskin mouth narrowing, causing urinary obstruction, the Air Force Chengdu Hospital on the surgical removal of the foreskin to do pathological examination, it can be seen that most of the foreskin group have inflammatory cell infiltration, a large number of muscle fiber fracture and thickening, and contains a lot of scar tissue.
Clinical manifestations and diagnosis Clinical manifestations of simple prepuce if there is no comorbidity, there are usually no clinical symptoms, such as the appearance of foreskin infection, etc. Symptoms of prepuce can appear. The clinical manifestations of prepuce and circumcision have the following 3 conditions.
1, local symptoms: the light can be asymptomatic, or only feel itching foreskin mouth, erection after discomfort, if secondary circumcision, can have foreskin mouth red swelling pain, urethral discharge increased, urination scratching pain, etc., can be accompanied by foreskin stones or foreskin scale accumulation, physical examination can be seen in the foreskin mouth red swelling, foreskin is too long, can barely turn up or can not turn up, foreskin cavity can be found in the stones, partners have foreskin leukoplakia, warts, etc., individual Cases can be accompanied by small penis, hidden penis and other congenital malformations.
2, obstructive symptoms: the main clinical manifestation of prepuce is the thinning of the urine line, urine flow deviation or spraying, or even drip-like. When urinating, urine enters the foreskin cavity first, making the foreskin swell, which is called the “second bladder”. A few of the more serious patients, long-term can cause chronic urinary retention, hydronephrosis, pyelonephritis, etc., but also because of the difficulty of urination and prolapse, groin mountain.
3, systemic symptoms: prepuce can cause sexual intercourse disorders, leading to infertility, adolescent patients are prone to induce masturbation vices, children can induce bedwetting phenomenon. During the day, there is frequent urination, secondary to urinary tract infection can appear feverish chills, urinary frequency and urgency.
If the foreskin opening is too small, or if the glans glans cannot be turned up to expose the glans due to adhesion of the foreskin, it is called prepuce. It should be noted that for pediatric patients, attention should be paid to distinguish between physiological prepuce or prepuce, and attention should also be paid to other genital lesions that may be accompanied and combined when diagnosing prepuce and prepuce.