It is evident that the opening of the prepuce becomes still narrower as a result of these inflammatory conditions, and that the urinary dis turbances increase, a harmful vicious cirele having been formed.
Further complications are, ascending cystitis, dilatation of the urinary bladder and the formation of hydronephrosis; in consequence of the forced action of intra-abdominal pressure there may appear a hydrocele, intestinal rupture and rectal prolapse. Even death by uraimia ultimately dependent upon phimosis has been described. Fur thermore, a whole series of nervous disturbances, syncopes, and epi leptiform convulsions, have been attributed to the presence of phimo si.s. The irritation of the external genitals produced by these conditions have resulted in masturbation even tluring infancy.
If the prepuce is forcibly retracted over the glans, the eventual result will be the disagreeable complication called paraphimosis, the strangulation of the penis by the narrow ring of the prepuce in the coronary sulcus. The immediate result is violent pain, interference with the circulation, the appearance of (edema, and, by the develop nient of inflammation, the occurrence of ulceration, phlegmon, and even gangrene of the glans.
Diagnosis.—We must. decide whether the case is a simple epithelial adhesion without stcnosis, or a real narrowing. The history given by the mother is not to be considered of any value in diagnosis.
If there exist symptoms of inflammation of thc prepuce, the urine should be examined without fail, since, as Rey has emphasized, a cystitis may have caused this inflammation which imitates a phimosis.
Treatment.—The reinoval of the phimosis may he effected by either bloodless, or bloody means. The bloodless method, aecording to Karewski, consists in freeing the epithelial agglutination by means of the flat end of a probe, and the gentle and eareful retraction of the prepuce over the glans. This must be effected with careful asepsis to avoid secondary inflammation, which leads to the formation of sear tissue. liarewski advises this method only in the eases of epithelial adhesions, while for the removal of phimosis lie proposes the operation of circumcision which is absolutely without danger when performed aseptically, and which is accomplished in a few minutes.. (For a descrip tion of this operation see works on Surgery.) The relief of paraphimosis is effected by reposition of the strangu lating ring. The reposition is effected hy embracing the strangulating ring with two fingers and trying to push it. back, while at the same time the thumb presses the glans into the prepuce. The reposition will more readily succeed after incision of the compressing preputial ring. Cold compresses, containing alum, will soon relieve the oalema and the inflammatory irritation, and after this the operation for phimosis may be undertaken.