Phimosis

　　Phimosis refers to the long foreskin and narrow foreskin opening, where the foreskin cannot be flipped up and the glans penis cannot be exposed. Phimosis is divided into three types: physiological phimosis, false phimosis, and true phimosis. True phimosis is further divided into congenital phimosis and secondary phimosis.

　　1. Physiological

　　Newborns will all experience physiological phimosis, but after 1 year, the foreskin and glans penis will gradually separate; at 3-4 years old, 90% of children will have expanded narrow foreskin openings, and the foreskin can be flipped up to expose the glans penis. Therefore, most physiological phimosis can heal itself by 3-5 years old.

　　2. False

　　False phimosis is what we call long foreskin, where the foreskin covers the urethral opening but can be flipped up to reveal the urethral opening and the glans penis.

　　3. True

　　What we usually refer to as phimosis is mostly true phimosis, where the foreskin opening is narrow, preventing the foreskin from being flipped over to reveal the glans penis. True phimosis is divided into congenital and secondary types. Congenital phimosis refers to adhesion between the foreskin and the glans penis at birth, which gradually absorbs after several months, and the foreskin and glans penis separate. Most boys can maintain the separation of the foreskin and glans penis until puberty. With the development and erection of the penis, the foreskin can retract and flip over to reveal the glans penis.

　　Adherent phimosis is caused by the accumulation of secretions under the foreskin of children with phimosis, which often stimulates the mucosa and can cause balanoposthitis, leading to phimosis. In addition, if the foreskin is too long and the glans penis is frequently stimulated, it can lead to the narrowing of the foreskin opening and adhesion with the glans penis, forming a secondary phimosis. This type of phimosis cannot heal itself. Generally, it is more appropriate to have surgery at around 4 to 5 years of age.

　　Phimosis is a common symptom in male friends. Most infants are born with phimosis due to adhesion between the prepuce and the head, and if the prepuce is not promptly复位 after being twisted and flipped, it can cause the prepuce to be tightly constricted around the coronal sulcus, leading to the obstruction of the return of the distal prepuce and the head, resulting in edema, hemorrhage, and a恶性循环. If not treated in time, it can lead to ulceration, even necrosis. Common complications include the following:

　　1. Incarcerated phimosis

　　When the phimosis is flipped over the coronal sulcus, the constricted prepuce orifice around the coronal sulcus forms an incarcerated ring, causing incarcerated phimosis, which leads to congestion and edema of the prepuce, infection, or necrosis. In adults, it is often caused by masturbation or sexual intercourse. If not timely corrected, it is easy to cause blood flow obstruction.

　　2. Long prepuce

　　It can become phimosis due to adhesion caused by inflammation, and a narrow prepuce orifice can affect urine flow. Long prepuce does not necessarily lead to phimosis, but phimosis can have long prepuce, and the condition of phimosis is more serious than that of long prepuce.

　　3. Prone to infection

　　The precipitates in the urine and the smegma accumulate inside the prepuce, becoming a culture medium for bacteria, or may cause infection and inflammation due to irritation, leading to prepuce adhesion. In severe cases, it may even cause infertility.

　　4. Prone to sexually transmitted diseases

　　Long prepuce or phimosis, due to the frequent exposure of the inner plate and glans to a moist environment, is prone to condyloma acuminatum, gonorrhea, and other sexually transmitted diseases, and due to the inability to be thoroughly cleaned locally, it is also easy to cause the wife to contract related diseases.

　　5. Tumor

　　Phimosis or long prepuce is closely related to tumors. Most urologists and experts believe that the formation of penile cancer is due to the pollution and chronic stimulation of urinary smegma, and penile papilloma is the main cause of cancer.

　　Phimosis refers to the complete covering of the glans by the prepuce, which cannot be exposed at any time. Long prepuce refers to the condition in adult males where the skin of the penis wraps the glans, preventing it from being fully exposed. It can be further divided into true long prepuce and false long prepuce. Phimosis is a manifestation of male physiological deformity, and many males suffer from phimosis. Phimosis can be divided into different types, and the treatment methods are also different.

　　1. Physiological phimosis

　　Some children have a narrow prepuce orifice, and during urination, the prepuce bulges like a bubble, causing incomplete urination and the need for two urinations, resulting in difficulty in urination. Phimosis often leads to balanoposthitis. Due to the stimulation of phimosis, it promotes secretion and desquamation of the epidermis, forming a white prepuce垢, which often accumulates in the coronal sulcus and is often mistaken for a mass by parents.

　　2. Congenital phimosis

　　Also known as pathological or scarred phimosis. It is characterized by a white, annular scar contracture band around the prepuce orifice, which can cause bleeding and pain if forcibly retracted, and exacerbate the scar. Scarred phimosis can often lead to recurrent balanoposthitis, narrowing of the prepuce orifice, and in severe cases, may be accompanied by urethral orifice stenosis.

　　Before phimosis patients undergo circumcision, they should pay attention to the local hygiene of the penis, frequently wash it, and do not force the prepuce to flip up if it cannot be flipped. If it can be flipped and cleaned, the prepuce should be returned to its original position after washing to avoid causing incarcerated phimosis. Three days before the circumcision, the penis should be washed with warm water or a 1:5000 concentration of potassium permanganate solution. After the operation, in addition to paying attention to the above medication to prevent penile erection, bleeding, and inflammation, attention should also be paid to the dryness of the bandage, and it should be replaced in time if it gets wet with urine. Generally, the suture is removed after 5 to 7 days.

　　Phimosis is a common urological disease in clinical practice. If the prepuce is not flipped back in time after it is flipped up, it can lead to the occurrence of incarcerated phimosis. The diagnosis of this disease generally does not require special examinations. It can be diagnosed by self-examination and medical technology examination.

　　First, self-examination

　　Self-examination mainly involves observing the symptoms produced, with the main phenomenon being:

　　1. The formation of prepuce垢, appearing as a white small mass.

　　2. The formation of incarcerated phimosis, with severe pain, prepuce swelling, and urinary difficulty. If left for too long, the incarcerated prepuce may necrose.

　　3. The formation of balanoposthitis, with the prepuce opening red and swollen, and purulent discharge.

　　4. The narrow prepuce opening can cause varying degrees of urinary difficulty, with slow and thin urine flow, and the prepuce may swell during urination.

　　5. During the examination, observe the size of the prepuce opening, try to flip the prepuce up, and a judgment can be made; when phimosis is incarcerated, the swollen prepuce is flipped over the corona of the penis, and a narrow ring can be seen at the top, with the glans penis appearing dark purple.

　　Second, medical technology examination

　　1. Observe the size of the prepuce opening: by trying to flip the prepuce up, a judgment can be made.

　　When phimosis is incarcerated, the swollen prepuce is flipped over the corona of the penis, and a narrow ring can be seen at the top, with the glans penis appearing dark purple.

　　Male friends who have phimosis will be very worried about its harm and hope to recover as soon as possible. If not treated in time, it will affect the patient's work and study. In order to recover to normal life as soon as possible, phimosis patients should pay attention to the following dietary points in their daily life.

　　After circumcision, it is advisable to eat more fruits and green vegetables. The diet after circumcision should be light, and it is also necessary to drink about 2 liters of water every day. It is also important to drink water properly, with more water during the day and less at night. Otherwise, frequent nighttime urination can be very torturous. You can also drink some cooling and fire-reducing herbal tea, which can suppress sexual desire, reduce libido, and promote wound healing.

　　No alcohol is allowed. Those who like to drink should be aware that during the recovery period, they must resist the temptation of alcohol. Alcohol can cause blood vessels to dilate, and after drinking, it may cause the penis to become erect, which can lead to the rupture of the circumcision wound and bleeding.

　　During the one-month period after circumcision, it is best to avoid eating hot pot, chili, and other spicy foods, as well as seafood and other fishy foods. Seafood and spicy foods are highly stimulating. If consumed in large quantities, the newly operated wound may be continuously stimulated, potentially causing inflammation and bringing pain to the patient.

　　4. Men should avoid or reduce the intake of seafood and cold, hard, spicy foods before and after circumcision, and the liver of animals must be fully cooked, do not eat cold dishes. Pay attention to avoiding spicy and刺激性 things in daily life, because Chengdu people's food is mainly spicy and hot, which is extremely unfavorable for the recovery after circumcision.

　　Phimosis and phimosis are common urological diseases in clinical practice. If the foreskin is not flipped back in time, it can lead to the occurrence of phimosis. Phimosis can affect the flow of blood and lymph, resulting in blood stasis or swelling. In traditional Chinese medicine, this kind of symptom often belongs to Qi stagnation and blood stasis, so it can be regulated by methods such as regulating Qi and removing stasis, and activating blood and removing stasis. Specifically, as follows:

　　1. Qi Stagnation Syndrome

　　Symptoms: The foreskin is flipped up to the corona, cannot be retracted, the foreskin is swollen, and there is pain accompanied by lower abdominal pain. The tongue is pale red with a thin white coating, and the pulse is tight.

　　Symptom Analysis: Long foreskin, small foreskin opening, cannot be复位 after being flipped up, meridians and collaterals are blocked, Qi and blood circulation is not smooth, leading to local swelling and pain.

　　Treatment Principle: Promote Qi, dredge through meridians, reduce swelling and relieve pain.

　　Prescription: Jinlingzi Powder and Huoluo Xiaolingdan. In the prescription, Jinlingzi relieves liver Qi and regulates Qi, Yanhusuo relieves Qi and stops pain, Danggui activates blood and nourishes blood, and Danshen opens meridians and relieves pain. The combination of drugs has the effect of opening meridians and relieving pain, promoting Qi and reducing swelling, and is suitable for patients with swelling that does not subside after reduction after phimosis.

　　2. Blood Stasis Syndrome

　　Symptoms: The tongue is dark red with macules or the coating is thin and yellow, the pulse is wiry and tight or wiry and rough.

　　Symptom Analysis: phimosis, blood and Qi are obstructed, blood vessels are滞，channels are blocked, and urination is not smooth. The tongue is dark red, the coating is thin and yellow, and the pulse is wiry and tight or wiry and rough, all indicating stasis in the meridians.

　　Treatment Principle: Activate blood circulation and remove stasis, dredge through meridians and relieve pain, with blood cancer as the main focus, symptoms mainly manifest as pain.

　　Prescription: Modified Qili Powder. In the prescription, blood coral, myrrh, myrrha, and safflower activate blood circulation and remove cancer, musk and borneol relieve pain, coptis and peony relieve pain, cinnabar calms the mind, and added yellow wine is taken. The combination of drugs has the effect of removing stasis, promoting blood circulation, and relieving pain.