Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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While circumcision is frequently performed for cultural or prophylactic reasons on healthy individuals, a significant portion of procedures at Liv Hospital are undertaken to address specific pathological conditions affecting the prepuce and glans. Understanding the symptoms and risk factors associated with these conditions is essential for determining when surgical intervention moves from being an option to a medical necessity. The foreskin, while physiological, is susceptible to a range of inflammatory, infectious, and structural disorders that can compromise urological health, sexual function, and overall quality of life. The decision to circumcise in a therapeutic context is driven by the failure of conservative treatments or the severity of the presenting symptoms.
The pathology of the foreskin is often progressive. What begins as minor irritation can evolve into scarring and permanent dysfunction if the underlying risk factors are not addressed. The warm, moist environment of the preputial sac is an ideal medium for bacterial and fungal proliferation, particularly in individuals with compromised immune systems or metabolic disorders. Consequently, the symptoms prompting medical circumcision are often categorized into problems of retractability, problems of infection, and problems of cutaneous malignancy.
Phimosis is defined as the inability to retract the foreskin behind the glans penis. It is crucial to distinguish between physiological and pathological phimosis. In neonates and young children, the foreskin is naturally adhered to the glans; this is physiological phimosis and typically resolves spontaneously by puberty. However, pathological phimosis involves the formation of a fibrous, non-elastic ring of tissue at the preputial opening, preventing retraction even with force.
Paraphimosis is a distinct and acute condition where the foreskin is retracted behind the glans but cannot be returned to its natural position. The tight preputial ring acts as a tourniquet around the penile shaft, impairing lymphatic and venous drainage while arterial supply continues. This leads to rapid and severe swelling of the glans and the retracted foreskin.
Balanitis refers to inflammation of the glans, while posthitis is inflammation of the foreskin; balanoposthitis is the combination of both. When this condition becomes recurrent or chronic (Recurrent Balanitis), circumcision is the curative standard of care.
Balanitis Xerotica Obliterans (BXO), also known as genital Lichen Sclerosus, is a chronic, progressive, inflammatory skin condition of unknown etiology that specifically targets the foreskin and glans. It causes the skin to become pale, atrophic, and scarred.
Risk Factors: The etiology is likely autoimmune. It is considered a pre-malignant condition in some contexts, as chronic inflammation is a pathway to squamous cell carcinoma. Circumcision is the only effective treatment to arrest the progression of BXO on the glans.
While less common in adults, recurrent UTIs in male infants and children are a significant indication for circumcision. The inner foreskin can become colonized with uropathogenic bacteria (like E. coli).
Penile cancer is rare, but it occurs almost exclusively in uncircumcised men. The accumulation of carcinogenic smegma and chronic inflammation are key drivers.
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Phimosis is a condition where the foreskin is too tight to be pulled back (retracted) over the head of the penis. It is generally a chronic condition. Paraphimosis is the opposite scenario and is an emergency; the foreskin is pulled back but gets stuck behind the head of the penis, acting like a tight rubber band that cuts off blood flow and causes severe swelling.
Yes, diabetes is a major risk factor for foreskin complications. High blood sugar levels result in glucose in the urine. This sugary environment under the foreskin allows yeast and bacteria to thrive, leading to chronic infections and inflammation (balanoposthitis). Over time, this chronic inflammation causes scarring and tightening of the foreskin, often necessitating circumcision.
Balanitis itself describes the inflammation, which can be caused by infection, irritation, or allergies. If the balanitis is caused by a sexually transmitted infection (like yeast, herpes, or gonorrhea), it is contagious. However, balanitis caused by irritation from soap or poor hygiene is not contagious. Circumcision prevents balanitis by removing the tissue that traps moisture and microbes.
Lichen Sclerosus (or BXO) causes aggressive scarring that can fuse the foreskin to the glans and turn the skin white and rigid. Beyond causing urinary blockage, it is considered a pre-malignant condition. Long-standing, untreated inflammation from Lichen Sclerosus increases the risk of developing squamous cell carcinoma of the penis, making circumcision a preventative health measure.
Yes, severe phimosis (tight foreskin) can make sexual intercourse painful. The friction during sexual activity can cause the tight skin to tear, bleed, or crack (fissures). It can also inhibit normal sensation or cause discomfort during erection because the skin cannot expand adequately. Circumcision resolves these mechanical restrictions, often improving sexual comfort.
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