PHIMOSIS
PHIMOSIS
PRESENTATION BY GROUP 10
1
INTRODUCTION
PHIMOSIS
• Phimosis is a
condition in which
the foreskin of the
penis cannot
stretch to allow it to
be pulled back past
the glans
2
PHIMOSIS
PRESENTATION TITLE
•True pathologic phimosis exists
when failure to retract is
secondary to distal scarring of the
prepuce.
•This scarring often appears as a
contracted white fibrous ring
around the preputial orifice.
3
CONT’D:
PRESENTATION TITLE
• In contrast, physiologic phimosis
consists of a pliant, unscarred
preputial orifice.
•Physiologic phimosis is common in
male patients up to 3 years of age,
but often extends into older age
groups.
•These 2 separate conditions are,
4
by and large, clearly
distinguishable on physical
TYPES OF PHIMOSIS
• Type 1: full retraction of foreskin, tight
behind the glans.
• Type 2: partial retraction, meatus just
visible.
• Type 3:slight retraction, but some
distance between tip and glans, i.e.
neither meatus nor glans can be
exposed.
• Type 4: absolutely no retraction of the
foreskin.
6
PHIMOSIS
CAUSES OF PHIMOSIS
PRESENTATION TITLE
•Poor hygiene..
•Skin conditions such as eczema,
psoriasis, lichen planus and lichen
sclerosus. When it affects your
penis, lichen sclerosis is known as
penile lichen sclerosis or balanitis
xerotic obliterans (BXO).
•Preputial adhesions, or scar
tissue, that keep the foreskin
7
attached to the tip (glans) of your
CAUSES OF PHIMOSIS
PRESENTATION TITLE
•Injuries.
•Infections, including sexually
transmitted infections (STIs).
• frenulum breve
8
SYMPTOMS OF PHIMOSIS
PHIMOSIS
Someone with phimosis may have the
following symptoms:
• Redness or discoloration, which may
occur when infected/irritated.
• Swelling (inflammation), which may
occur when infected/irritated.
• Soreness.
• Pain while urinating (dysuria).
9
• Pain with erections or with sexual
activity.
DIAGNOSIS
PRESENTATION TITLE
•Phimosis can diagnose
phimosis during a physical
examination.
•In addition, they might order
tests to find out if there’s an
infection present in urine or
penis discharge.
10
SURGICAL MANAGEMENT
PRESENTATION TITLE
•Surgical methods range from the
complete removal of the foreskin
to more minor operations to
relieve foreskin tightness:
•Dorsal slit (superincision) is a
single incision along the upper
length of the foreskin from the tip
11
to the corona, exposing the glans
without removing any tissue.
SURGICAL MANAGEMENT
PRESENTATION TITLE
•Ventral slit (subincision) is an
incision along the lower length of
the foreskin from the tip of the
frenulum to the base of the glans,
removing the frenulum in the
process. Often used when
frenulum breve occurs alongside
the phimosis.
12
CONT’D
PRESENTATION TITLE
• Preputioplasty, in which a limited dorsal slit
with transverse closure is made along the
constricting band of skin, can be an effective
alternative to circumcision.
• It has the advantage of only limited pain and
a short healing duration relative to
circumcision, while also avoiding cosmetic
13
effects.
CONT’D
PRESENTATION TITLE
•Circumcision is sometimes
performed for phimosis, and is an
effective treatment.
14
PRESENTATION TITLE
15
PARAPHIMOSIS
PARAPHIMOSIS
INTRODUCTION
Paraphimosis is an uncommon
medical condition in which the
foreskin of a penis becomes
trapped behind the glans
penis, and cannot be reduced.
Paraphimosis is a medical
16
emergency.
CAUSES
PRESENTATION TITLE
• Paraphimosis is usually caused by
medical professionals (iatrogenic)
or parents who handle the foreskin
improperly.
• The foreskin may be retracted during
penile examination, penile cleaning,
urethral catheterization, or
cystoscopy
• if the foreskin is left retracted for a
long period, some of the foreskin
17 tissue may become edematous
(swollen with fluid), which makes
SYMPTOMS OF
PARAPHIMOSIS
PRESENTATION TITLE
Symptoms of paraphimosis
include:
•Inability to pull the foreskin
forward over the head of the
penis to the tip. (Putting the
foreskin back into its proper
place is called foreskin
reduction.)
18
•Pain.
DIAGNOSIS
PRESENTATION TITLE
•Paraphimosis can diagnose
phimosis during a physical
examination.
•One will probably notice the
penis has some swelling and
discoloured.
19
MANAGEMENT OF PARAPHIMOSIS
PRESENTATION TITLE
•Open circumcision surgery:
This is the conventional surgery
for circumcision. It involves
sedating the patient with local or
general anesthesia.
20
MANAGEMENT OF
PARAPHIMOSIS
PRESENTATION TITLE
•Laser circumcision surgery:
This is a minimally-invasive
method of circumcision, which
only takes about 20 minutes.
21
MANAGEMENT OF
PARAPHYMOSIS
PRESENTATION TITLE
•Stapler circumcision
surgery: In this advanced and
minimally-invasive method of
circumcision, the surgeon uses
a surgical stapler to extract
the skin and close its edges.
22
COMPLICATIONS
PRESENTATION TITLE
•Pain
•Infection
•Inflammation of the
glans penis
23
VARICOCELE
24
VARICOCELE
PRESENTATION TITLE
25
VARICOCELE
PRESENTATION TITLE
•The scrotum is a skin-covered sac
that holds your testicles. It also
contains the arteries and veins
that deliver blood to the
reproductive glands.
• A vein abnormality in the scrotum
may result in a varicocele.
•A varicocele is an enlargement of
26
the veins within the scrotum.
• These veins are called the
CONT’D
PRESENTATION TITLE
•A varicocele only occurs in the
scrotum and is very similar to
varicose veins that can occur
in the leg.
•A varicocele can result in
decreased sperm production
and quality, which in some
cases can lead to infertility.
27
•It can also shrink the testicles.
CAUSES OF VARICOCELE
PRESENTATION TITLE
•There are no established risk
factors for developing a varicocele,
and the exact cause is unclear
•Varicoceles are believed to be
caused by defective valves in the
veins within the scrotum, just
above the testicles.
28
CAUSES OF VARICOCELE
PRESENTATION TITLE
• Normally, these valves regulate
the flow of blood to and from the
testicles.
• When normal flow doesn’t occur,
the blood backs up, causing the
veins to dilate (enlarge).
•This most commonly takes place
during puberty, when the testicles
29
are experiencing rapid growth and
need the most blood
DIAGNOSIS OF
VARICOCELE
PRESENTATION TITLE
• Physical exam. Because a
varicocele can’t always be felt or
seen when you’re lying down, your
doctor will most likely examine your
testicles while you’re standing up and
lying down.
• Valsalva maneuver. This technique
is often used to diagnose smaller
varicoceles. The Valsalva maneuver
typically requires you to stand, take a
30
deep breath, hold it, and bear down
while the doctor examines your
DIAGNOSIS OF VARICOCELE
PRESENTATION TITLE
•Scrotal ultrasound. In some
cases, a scrotal ultrasound may
be necessary. This helps measure
the spermatic veins and allows
your doctor to get a detailed,
accurate picture of the condition.
31
TYPES
PRESENTATION TITLE
•Grade I: able to be felt only
when the patient is straining
(valsalva maneuver)
•Grade II: able to be felt at rest,
but not visible
•Grade III: clearly visible on
exam
32
MANAGEMENT
PRESENTATION TITLE
• Percutaneous Embolization:
• Embolization is done by an
Interventional Radiologist. Injection of
contrast through a tube with x-ray
guidance is used to see the source of
the problem.
• The goal is to find all veins leading to
the varicocele. Coils (plugs with or
without sclerosant, a dehydrating drug)
33 are used to block the blood flow to the
varicocele.
CONT’D
PESNTATION TITLE
•Microscopic
varicocelectomy: The
surgeon makes a tiny incision
low in the groin. Using a
powerful microscope, the
surgeon identifies and ligates
several small veins. The
procedure usually lasts 2 to 3
34 hours.
CONT’D
PRESENTATION TITLE
• Laparoscopic
varicocelectomy: The surgeon
performs the procedure using a
video camera and surgical tools
attached to tubes that pass through
a few very small incisions in the
lower abdomen.
• Because the network of veins are
less complex above the groin, there
35
are fewer veins to ligate. The
procedure usually last 30 to 40
ADJEI DANIEL KUSI
PRISCILLA OTENG
AGYEI
ANITA FOSU
MUSAH ZENABU
CYNTHIA OPOKU
THANK YOU
THANK YOU
