Easter College INC. BSN 2B

1. PHIMOSIS

2. Inability of the prepuse (foreskin) to be retracted
behind the glans penis in uncircumcised males
After a few m onths, the adhesions dissolves & the
foreskin becomes retractable
If it does not, the infant has phim osis
associated with balanitis xerotica obliterans
DEFINITION

4. TYPES OF PHIMOSIS
PHYSIOLOGICAL
occurs naturally in
newborn
formation of the prepuce
is com pleted by 16 weeks
gestation
epithelium separates via
desquamation

5. TYPES OF PHIMOSIS
PATHOLOGICAL
inability to retract the
foreskin
chronic balanosphitis
fibrotic ring of tissue
balanitis xerosis
obliterans (BXO)

6. 4% of new-borns have retractable foreskin
by the age of 3, 90% of the prepuce are retractable
Rem aining 10%, w ill have physiologic phim osis
1%of 16-year-old will have non-retractable foreskins
46.5% of adult circumcision was attributed to phimosis
EPIDEMIOLOGY

7. NON-MODIAFIABLE FACTORS
-age
-gender
PATHOPHYSIOLOGY
MODIFIABLE FACTORS
-poor hygiene
-episodes of balanitis & balanoposthitis white fibrotic ring of the tissue
-ballooning of the foreskin during voiding
-penile pain
-dysuria
-urinary infection
unable to retract by the age of 3
able to retract by 16
weeks of gestation
recurrence of balanitis/ balanosposthitis
PHIMOSIS
early symptom of Diabetes Mellitus
stenosis scarring and pallor of the preputial opening

8. DIAGNOSTIC PROCEDURE
Blood and or Urine Test
to measure the blood sugar levels in the body.
may be a risk factor for type 2 diabetes mellitus
Penile Swab Test
to check the foreskin for bacteria
Urinalysis
to check for urinary tract infection

9. *HISTORY
>AGE
>SYMPTOMS
-Ballooning of foreskin during voiding
-Penile pain
-Dysuria
-Urinary Infections
CLINICAL PRESENTATION
*
PHYSICAL EXAMINATION
>Inspection
-redness
-purulent foreskin
-scarring of the foreskin
>Palpation
-tenderness
>Retraction of the foreskin not
possible

10. Grade I- Fully retractable prepuce with
stenotic ring in the shaft
Grade II- Partial retractability with partial
exposure of the glans
Grade III- Partial retractability w ith
exposure of the meatus only
Grade IV- Partial retractability with
neither the meatus or glans is exposed
Grade V- No retractability
SCORING SYSTEM

11. MANAGEMENT
*
Reassurance and Vigiliance
-Proper preputial care and hygiene
*
Topical Steroids
-0.05% Betamethasone bid for 4-6 weeks
*
Dilatation and Stretching
*Surgical
-Conservative Surgical Alternatives
-Conventional Male Cirrcumcision

12. DILATATION AND STRETCHING

13. MANAGEMENT
-Conservative Surgical Alternatives: Preputioplasty
Preservation of the foreskin, erogenous, and sexual
physiolofoc functions
Disadvantage: recurrence
other method: Meatoplasty and Frenuloctomy

14. MANAGEMENT

15. TYPES OF CIRCUMCISION
Using surgical devices
Gomco Clamp
Mogen Clamp
Plastibell
Dorsal Slit/ Free-hand
Excision
sleeve resection

16. CIRCUMCISION
INDICATIONS
Religious, cultural,
hygienic
phimosis
paraphim osis
balanitis
posthitis
CONTRAINDICATIONS
Hypospadias
Epispadias
Chordee
Penile webbing
Buried penis
Ambiguous genitalia
megalourethra

17. CIRCUMCISION
BENEFITS:
Reduce penile cancer
Reduce UTI occurence rate
Reduce STI transmission rates
Reduce cervical cancer rate in female partner

18. TYPES OF CIRCUMCISION

19. TYPES OF CIRCUMCISION
DORSAL SLIT/FREE-HAND

20. TYPES OF CIRCUMCISION
EXCISION- SLEEVE

21. health teaching specifically on:
-Penile hygiene routine with gentle retraction while
cleansing the underneath of the forskin
-not to forcibly retract the foreskin
- after retraction, the foreskin should be pulled back
over the head of the penis and return to its normal postion
NURSING INTERVENTIONS

22. ACTIVITY
-encourage bed rest for a few days
-instruct to avoid straddling activities, contact sports and
swimming for 3 to 4 weeks or until compltely healed
-recommend sponge bath the day after surgery
DIET
-encourage hydration for the first 24 hours after surgery
MEDICATION
-advise to take medicines as prescribed by the doctor
WOUND CARE
-reiterate hand hygiene before touching the incision site
-encourage wearing loose fitting underwear
-instruct to clean the surgical site with warm water and pat it dry
-advise to keep the incision site clean and dry
NURSING INTERVENTIONS

23. PARAPHIMOSIS

24. Inability to replace the prepuce over the glans once it
has been retracted
inability to reduce foreskin (stuck in retraction)
PARA-
PHIMOSIS

26. Relative uncommon condition
The incidence in unknown
Occur in about 1% of all adult m ales over 16 years of age (Bragg,
2022)
Alm ost alw ays an iatrogenically or inavertently induced
condition
EPIDEMIOLOGY

27. IATROGENIC CAUSES
>Penile examination
>Urethral catherization
>Cystoscopy
OTHER CAUSES
>Self-inflicted injury to the penis
>Secondary to penile erection
AETIOLOGY

28. Retraction
of the
foreskin
Phimotic
Ring
Vascular
Engorgement
Impediment of the
aarterial flow and
potential ischemia
PATHOPHYSIOLOGY
Eventual
Necrosis
PARA-
PHIMOSIS

29. There are no tests required to diagnose
paraphimosis. The Doctor will conduct a
physical examination and diagnose it.
Diagnosis is made clinically by direct
visualization, as well as the inability to
easily reduce the retracted foreskin
manually.
DIAGNOSTIC PROCEDURES

30. *HISTORY
AGE
SYMPTOMS
>Swelling
>Penile pain
>Obstructive voiding
>routine cleaning of the penis
PAST MEDICAL HISTORY
>No history of circumcision
>History of endoscopic surgery of
the bladder or urethra
CLINICAL PRESENTATION
*
PHYSICAL EXAMINATION
>Presence of the foreskin
>Color of the glans
>Degree of constriction
>Palpation of the glans

31. *
TREATMENT MODALITIES INCLUDES:
>
Medical Therapy
>
Surgical Therapy
MANAGEMENT
*
THE GOALS OF MANAGEMENT INVOLVES:
>Reassuring the patient
>Reducing the preputial edema
>Restoring the prepuce to its original
position and condition

32. PHARMACOLOGIC MANAGEMENT
*PHARMACOLOGICAL
>Injection of hyaluronidase into edematous
prepuse(Dundee technique)
>Osmotic agents (Mannitol soaked-gauze)
*Non-pharmacological
>
Ice packs
>Manual Reduction

34. *
MINIMALLY INVASSIVE
>Puncture technique
>Blood aspiration
*
DORSAL SLIT
*CIRCUMCISION
SURGICAL MANAGEMENT

37. *Associated with Paraphimosis
>Infection
>Swelling of the glans
>ischemia and necrosis
*Associated with Dorsal Slit
>Infection
>Bleeding
>
Urethral injury
>
Shortening of penile skin
COMPLICATIONS

38. ACTIVITY
-encourage bed rest for a few days
-instruct to avoid straddling activities, contact sports and
swimming for 3 to 4 weeks or until compltely healed
-recommend sponge bath the day after surgery
DIET
-encourage hydration for the first 24 hours after surgery
MEDICATION
-advise to take medicines as prescribed by the doctor
WOUND CARE
-reiterate hand hygiene before touching the incision site
-encourage wearing loose fitting underwear
-instruct to clean the surgical site with warm water and pat it dry
-advise to keep the incision site clean and dry
NURSING INTERVENTIONS

39. R
E
F
E
R
E
N
C
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Sm eltzer, S. C. O., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s
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