There have been several calls from hospital emergency staff in the recent past to alleviate retention of urine in elderly male and the associated pain. The urethral opening is completely closed by phimosed prepuce, the fore skin of penis. The common cause of retention of urine in elderly male is a prostatic enlargement. And in a situation where there is such type of phimosis remains associated, it gives rise to problem in introducing a silicon pipe through urethra to relieve the acute retention. Such type of peculiar situation probably is best encountered in India; where the people do not give attention to the phimosis they might be carrying from their childhood. Here, there is custom circumcision in Muslims and Hindus only go for it as a part of medical treatment. Perhaps there is no atheistic consideration, and people generally shy away from speaking about it. Even these people had enjoyed a good family life.
In this situation, first the prepuce is to be slit open to see the urethra, and glans is to be inspected for cancerous growths; as phimosis is associated with penile cancer in glans and prepuce. Many times there have been very much narrowing of urethral opening to obstruct the passage of urine. The urethra is to be dilated to allow the entry of a silastic pipe called catheter, and first of all the retention is to be relieved as it is a very painful condition, better known to a person who might had been compelled to postpone passing urine after the urge for it due to some reason. After that, a formal circumcision has to be performed. The stricture of urethral meatus may need a minor surgery to keep it open. All these can be performed under local anesthesia.
Though phimosis is apparently an innocent disease may a cause of grave concern.
This article was found in “The Lancet” a medical journal.It has interesting findings on transmission of HIV(Human Immunodeficiency Virus) to female from male infected partner. There has been other reports that it prevents .Circumcision on medical grounds other than custom should not denied to anybody including HIV infected .The UNAID /WHO also recommends in the same line.The details can be found in their web site.Circumcision during early childhood prevents cancerpenis as seen in case of Jews who own the custom.A patient of Phimosis should undergo circumcision.And any other person voluntarily wanting circumcision should be provided.The traditional methods of HIV/AIDS prevention are to be adhered to.
Observational studies have reported an association between male circumcision and reduced risk of HIV infection in female partners. We assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners.
Interpretation
Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.
Paraphimosismostly seenin children and adolescents .When a phimosed i.e. non retractile prepuce of penis though tight yet yields to forcible retraction and not reduced acts as a constricting ring behind the glans.This obstructs the return of fluid from from the distal part of penis.The ring swells and exerts increasing pressure to return of fluid and gives rise to a grotesque appearance. It is painful and requires medical attention.The prepuce has to be reduced after relieving the constricting ring of skin.May require a formal circumcision but better defered if there is a lot of oedema in that part. Recently I came across an article in “The Times of India” which says circumcision prevents Cancer of penis,HIV and Herpes infection in persons undergone circumcision in very early life as stated by the researchers.I had also seen similar news sometime back in a news paper.As per book it has been seen that cancer of penis is very rarely seen in Jews who undergo circumcision in very early childhood as a custom.It is definitely not known what prevents this. More research has to be undertaken to reach in the conclusion of circumcision can prevent HIV.
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PARAPHIMOSIS OF PENIS
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