Phimosis

A. Definition
Phimosis is a condition in which the foreskin (prepuce) attached to the head of the penis (glans) and cause blockage of the urinary tract opening, so that infants and children, so the difficulty and pain when urinating.

B. Pathophysiology
Phimosis experienced by most newborns because there is a natural adhesion between the foreskin to the glans penis. Until the age of 3-4 years penis grow and develop and debris generated by the epithelium of the foreskin (smegma) to accumulate in the foreskin and slowly separating the foreskin from the glans penis. Erection of the penis that occurs periodically make prepuce dilated slowly so that the foreskin becomes retractile and can be pulled proximally. At the age of 3 years, 90% of the foreskin can already be retracted.

But in some children, the foreskin remains sticky on the glans penis, prepuce so that the tip narrowed and eventually can disrupt the function of micturition / urination. Smegma happen from mucosal cells prepuce and glans penis which experienced desquamation by bacteria that are inside.

C. Signs and symptoms
Signs and symptoms of phimosis are:
1. The penis is enlarged and distended due to the piles of urine
2. Sometimes a complaint can be the tip of the pubic bulge at the start of micturition which then disappears after urination. It is caused by the urine coming out beforehand stuck in a room that is limited by the skin on the tip of the penis before exiting through the narrow estuary.
3. Normally the baby is crying and straining when urinating due to the pain arises.
4. The foreskin is not biased toward the base when drawn will be cleared
5. The urine out is not smooth. Sometimes a trickle and sometimes radiating to the direction unpredictable
6. It could also be accompanied by fever
7. irritation of the penis.

D. Causes
Phimosis can be caused by balanopostis. Balolopostis a thorough inflammation at the head of the penis (glans penis) and skin. Inflammation usually occurs akiabat fungal or bacterial infection under the skin of the penis is uncircumcised. The penis becomes pain, itching and redness and swelling can menybabkan narrowing of the urethra.

E. Complications
1. discomfort / pain when urinating
2. The accumulation of secretions and smegma under the foreskin is then exposed to secondary infections and eventual scarring.

3. In severe cases can cause urinary retention.
4. Withdrawal of the foreskin is paksadapat result kontriksi with pain and swelling of the glans penis, called paraphimosis.
5. The swelling / inflammation of the pubic tip called balinitis.
6. Arising infection in the urinary tract (ureter) left and right, then cause damage to the kidneys.
7. Phimosis is a risk factor for cancer of the penis.

F. Treatment
 Not recommended doing a forced retraction, because it can cause injury and cicatricial formed at the tip of the foreskin so that it will form a secondary phimosis
 Maintain personal hygiene, especially washing the penis and penis with plenty of soap.
 Phimosis accompanied xerotica balanitis obliterans can be given dexamethasone 0.1% ointment smeared 3/4 times, and is expected after 6 weeks of administration of the foreskin can be retracted spontaneously.
 Phimosis with complaints of micturition, ballooning tip of the foreskin during micturition or infection postitis an indication for circumcision, where the phimosis accompanied balanitis / postitis should be given antibiotics beforehand.