OCCLUSION OR OBLITERATION of the prwputial orifice may not be detected im mediately after birth, but the appearance of a tumor at the end of-the penis due to the accumulation of urine will soon call attention to the trouble. The treat ment of this condition is circumcision.
SHORT FR2ENUM.—This congenital de formity occasionally interferes with com plete erection, turning the orifice of the meatus down, and not only preventing ejaculation in the proper direction, but rendering coitus painful or impossible.
base of the frrenurn should be divided by a narrow bistoury, and the prepuce kept retracted until healing is complete.
Phimosis.—A preternatural elongation of the prepuce with a contracted orifice rendering it impossible to uncover the glans penis is termed phimosis. The pra3 putial orifice may be so small that a probe cannot he made to pass ("pin-point" ori fice).
Varieties.-1. Congenital (always per manent). 2. Acquired: inflammatory (usually temporary); cicatricial (always permanent).
CONGENITAL—The prepuce begins as a fold of tissue about the third month of foetal life; as it gro ;vs forward, the inner surface of the foreskin becomes adherent to the glans penis. During the first year of life the prepuce generally becomes loosened; should this not occur a true phimosis results.
ACQUIRED.—The acquired may be either inflammatory or cicatricial. The inflammatory— bal anoposth itis — usually occurs as a result of various forms of ulceration about the glans and prepuce. Cicatricial contraction results from the healing of ulcers, injuries, and bad cir cumcisions—the mucous membrane be ing left too long, thus permitting the scar to slip in front of the corona glandes.
Symptoms.—Moderate phimosis may exist without giving rise to symptoms. However, as a result of the decomposition of the retained smegma and urine and obstruction to the flow of urine, symp toms may develop which are exceedingly distressing and may permanently impair the general health. In children there are symptoms which often simulate vesical calculus: balanitis, heat, itching, pain at the head of the penis, frequent erec tions, pain on urination, frequency of micturition, dysuria, or incontinence.
tinder the remote effects may be consid ered malnutrition, choreic movements, paralysis, convulsions, prolapse of the rectum, hernia, atony of the bladder, the latter conditions being most frequently seen when there is marked contraction of the praputial orifice requiring sevei straining efforts to be made during urina tion. In older children the condition is apt to give rise to priapism, and is un doubtedly the cause of masturbation and often an arrest of development of the penis.
After puberty and later, functional sexual troubles begin: erections occasion intense pain, the repeated attacks of balanoposthitis reflexly predispose to noc turnal emissions, and coitus is painful or impossible.
When phimosis is unrelieved, the irri tation of chronic balanoposthitis is the frequent cause of fissures, vegetations, and adhesions, in later life, and, in con sequence of it, cancer is liable to occur.
Phimosis is a strong predisposing fac tor of penile cancer. Direct contagion seems to be the cause in some instances.
Edward Martin (Jour. of Cut. and Genito-Urin. Dis., Mar., '95).
It is not uncommon in long-standing cases of phimosis to find one or more cal culi beneath the prepuce due to decom position of the urinary salts. These cal culi may be very small, but, however, may weigh several ounces.
Treatment. — Permanent phimosis, whether congenital or acquired, should always be treated by operation (circum cision). In the majority of instances congenital phimosis is spontaneously re lieved. If the epithelial separation is not complete at birth, it may be quickly accomplished by the flat end of a probe, the raw surface left being covered with carbolized oxide-of-zinc ointment to pre vent adhesions.
For temporary phimosis following in flammations and ulcerations subpm putial injections of Castile soap and hot water with a flat-nozzeled syringe should be made twice daily, followed by the use of a lead-water-and-laudanum solution to which 1/, drachm of carbolic acid has been added to every 6 ounces. During the day the entire organ should be sur rounded with lead-water and laudanum.