Prepuce means that the foreskin cannot be completely turned up to reveal the head of the penis. Physiological adhesions between the foreskin and the head of the penis are normal in infancy, and as the penis grows and develops, the adhesions are gradually separated and absorbed, and the foreskin can recede upward on its own. There are individual differences in the age at which the head of the penis is exposed. According to the survey, after the age of 10, only 2-3% have prepuce, and even less in adolescence.
Circumcision means that the foreskin covers the head of the penis, but can be turned up so that the head of the penis is exposed, which is also normal in children.
The foreskin is turned over to the upper part of the head of the penis, and the foreskin ring is tightly strangled in the coronal groove, resulting in venous and lymphatic flow obstruction, causing edema of the head of the penis and making the foreskin unable to recover.
(A) Clinical manifestations
1.Narrow prepuce opening Pinhole-like, can cause different degrees of urinary difficulties, slow and small urine flow, foreskin puffing up when urinating.
2.Circumcision accumulates under the foreskin and consists of sebaceous gland secretions and epithelial debris, and appears as a small white lump.
3.Penis head circumcision Bacterial infection occurs, acute inflammation of the foreskin mouth redness, swelling, purulent secretions.
4, embedded prepuce Pain is intense, foreskin edema, there is difficulty in urination, too long embedded foreskin can occur necrosis.
(B) Inspection
1, observe the size of the foreskin mouth will try to turn up the foreskin, you can make a judgment, foreskin should be distinguished from prepuce. After inspection, the upturned foreskin should be pushed down in time to avoid imbrication.
2, embedded prepuce, edema foreskin turned in the coronal groove of the head of the penis, in its upper edge can be seen narrow ring, the head of the penis is dark purple.
Treatment
1.Manipulation to expand the foreskin mouth early childhood prepuce, can repeatedly try to turn up the foreskin, so that the foreskin mouth expansion. The technique should be gentle, not too eager to retract the foreskin up. When the head of the penis is exposed, remove the prepuce, apply antibiotic ointment or liquid paraffin to lubricate it, and then restore the foreskin. Most children can be cured by this treatment as they grow older.
2, circumcision is suitable for: ① foreskin mouth with fibrous narrow ring. ② Recurrent episodes of penile head circumcision. ③After 6 years of age, the foreskin mouth is narrowed and the foreskin cannot be retracted to reveal the head of the penis.
In principle, circumcision can be performed on children of any age, but according to the situation in our hospital, children under 8 years of age generally need to be hospitalized, and children over 8 years of age can be operated on an outpatient basis.
Special emphasis is placed on the fact that circumcision should not be performed in cases of occult penis, and that correction of occult penis should be performed.
If the surgeon performs circumcision on the occult penis as a general circumcision, after the operation, not only can the penis return to its normal anatomical position, but also lose part of the foreskin, causing shortening of the foreskin and bringing more difficulties to the future treatment.
3, the head of the penis foreskin infection in the acute phase of the application of antibiotics, local daily with warm water or dilute potassium permanganate solution soaked several times. After the inflammation has subsided, first try to separate the foreskin by hand, local cleaning treatment, when invalid for circumcision.
4, embedded prepuce with the reset, in the coronal groove of the penis after applying liquid paraffin, hold the head of the penis and gradually pressurize, squeeze the head of the penis with the two thumbs, the index and middle fingers of both hands will foreskin back down, so that the reset. Sometimes thick needles can be added to puncture the foreskin in multiple places and squeeze out the watery fluid to help reset. After the reset, circumcision is performed at an optional stage. If the reset fails, urgent dorsal circumcision of the foreskin.
5, foreskin is too long if the foreskin mouth is wide and easy to turn up, to often turn up and clean, to keep the local clean, can not operate.