In phimosis, the prepuce (foreskin) is too tight to be retracted to reveal the glans penis. Physiologic phimosis occurs naturally in newborn males. La fimosis tiene que distinguirse de la aglutinación normal del prepucio con el glande, que es un fenómeno fisiológico (2). La parafimosis debe considerarse. This video may be inappropriate for some users. Sign in to confirm your age. Watch Queue. Queue. Watch QueueQueue. Remove all.

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Kelainan Fimosis Phimosis Fimosis phimosis Merupakan kondisi dimana kulit yang melingkupi kepala penis glans penis tidak bisa ditarik ke belakang untuk membuka seluruh bagian kepala penis kulup, prepuce, preputium, foreskin.

Fimosis, Parafimosis, Hipospadi n Sirkumsisi – PDF Free Download

Aprafimosis terdiri dari dua lapis, bagian dalam dan luar, sehingga dapat ditarik ke depan dan belakang pada batang penis. Pada fimosis, lapis bagian dalam preputium melekat pada glans penis.

Kadangkala perlekatan cukup luas sehingga hanya bagian lubang untuk berkemih meatus urethra externus yang terbuka. Fimosis phimosis bisa merupakan kelainan bawaan sejak lahir kongenital maupun didapat, Parafimosis parafi,osis Merupakan kebalikan dari fimosis dimana kulit preputium setelah ditarik ke belakang batang penis tidak dapat dikembalikan ke posisi semula ke depan batang penis sehingga penis menjadi terjepit.

Fimosis dan parafimosis yang didiagnosis secara klinis ini, dapat terjadi pada penis yang belum disunat disirkumsisi, circumcision atau telah dikhitan namun hasilnya kurang baik. Fimosis dan parafimosis dapat terjadi pada laki-laki semua usia, namun kejadiannya tersering pada masa bayi dan remaja.

Fimosis kongenital kelainan bawaan, true phimosis Kulit preputium selalu melekat erat pada glans penis dan tidak dapat ditarik ke belakang pada saat lahir, namun seiring bertambahnya usia serta diproduksinya hormon dan faktor pertumbuhan, terjadi proses keratinisasi lapisan epitel dan deskuamasi antara glans penis dan lapis bagian dalam preputium sehingga akhirnya kulit preputium terpisah dari glans penis.

Parafi,osis didapat fimosis patologik Hal ini berkaitan dengan kebersihan higiene alat kelamin yang buruk, peradangan kronik glans penis dan kulit preputium balanoposthitis kronikatau penarikan berlebihan kulit ffimosis forceful retraction pada fimosis kongenital yang akan menyebabkan pembentukkan jaringan ikat fibrosis dekat bagian kulit preputium yang membuka.

Gejala fimosis Fimosis kongenital seringkali menimbulkan fenomena ballooning, yakni kulit preputium mengembang saat berkemih karena desakan pancaran air seni tidak diimbangi besarnya lubang di ujung preputium. Fenomena ini akan hilang dengan sendirinya, dan tanpa adanya fimosis patologik, tidak selalu menunjukkan adanya hambatan obstruksi air seni. Selama tidak terdapat hambatan aliran parafimoxis seni, buang air kecil berdarah hematuriaatau nyeri preputium, fimosis bukan merupakan kasus gawat darurat.

Indikasi medis utama dilakukannya tindakan sirkumsisi pada anak-anak adalah fimosis patologik. fimosie

Fimosis, Parafimosis, Hipospadi n Sirkumsisi

American College of Emergency Physicians Disclosure: Background Phimosis refers to the inability to retract the distal foreskin over the glans penis. Physiologic phimosis occurs naturally in newborn males. Pathologic phimosis defines an inability to retract the foreskin after it was previously retractible or after puberty, usually secondary to distal scarring of the foreskin. Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus.

Paraphimosis is a disease of uncircumcised or partially circumcised males. Anatomy of the penis. Physiologic phimosis results from adhesions between the epithelial layers of the inner prepuce and glans. These adhesions spontaneously dissolve with intermittent foreskin retraction and erections, so that as males grow, physiologic phimosis resolves with age.

Poor hygiene and recurrent episodes of balanitis or balanoposthitis lead to scarring of preputial orifices, leading to pathologic phimosis. Forceful retraction of the foreskin leads to microtears at the preputial orifice that also leads to scarring and phimosis.

Elderly persons are at risk of phimosis secondary to loss of skin elasticity and infrequent erections. Penile piercings increase the risk of developing paraphimosis if pain and swelling prevent reduction of a retracted foreskin. With time, impairment of venous and lymphatic flow to the glans leads to venous engorgement and worsening swelling. One to five percent of males will have nonretractible foreskins by age 16 years.

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Sex Phimosis and paraphimosis affects males only. Age Phimosis and paraphimosis can occur at any age. Parents of patients with physiologic phimosis may bring in the patient after noting an inability to retract the foreskin during routine cleaning or bathing.

Parents may also be alarmed by “ballooning” of the prepuce during urination — a normal finding. Pathologic phimosis may be detected in males who report painful erections, hematuria, recurrent urinary tract infections, preputial pain, or a weakened urinary stream.

Physiologic phimosis versus pathologic phimosis. Paraphimosis classically presents with a painful, swollen glans penis in the uncircumcised or partially circumcised patient.

A preverbal infant may present only with irritability. Occasionally, the paraphimosis may be an incidental finding noted by a caretaker of a debilitated patient.

Paraphimosis is classically seen in one of the following populations: Physical Phimosis The foreskin cannot be retracted proximally over the glans penis. In physiologic phimosis, the preputial orifice is unscarred and healthy appearing. In pathologic phimosis, a contracted white fibrous ring may be visible around the preputial orifice Physiologic phimosis versus pathologic phimosis.

Paraphimosis The foreskin is retracted behind the glans penis and cannot be replaced to its normal position. The foreskin forms a tight, constricting ring around the glans. Flaccidity of the penile shaft proximal to the area of paraphimosis is seen unless there is accompanying balanoposthitis or infection of the penis.

With time, the glans becomes increasingly erythematous and edematous. The glans penis is initially its normal pink hue and soft to palpation. As necrosis develops, the color changes to blue or black and the glans becomes firm to palpation. Differentials Anasarca Angioedema Balanitis Bites, Insects Cellulitis Dermatitis, Contact Foreign body tourniquet, including hair, thread, metallic object, or rubber bands Penile carcinoma Penile fracture Penile hematoma Laboratory Studies Phimosis and paraphimosis are clinical diagnoses, and laboratory and imaging studies are not indicated.

Emergency Department Care Patients with phimosis rarely require any emergency intervention and should be referred to a urologist as on an outpatient basis prior to development of irreversible penile damage. A paraphimosis is a urologic emergency and needs to be attended to immediately.

Many techniques of paraphimosis reduction have been described in case studies, though none have been tested in randomized control trials. When necessary, all of the following procedures can be facilitated by the use of local anesthesia, a penile block using lidocaine hydrochloride without epinephrine or, especially in children, conscious sedation. Sterile technique should be used for all invasive procedures.

The authors recommend attempting to reduce the paraphimosis in the following sequence, from least to most invasive. The urologist should be involved early on in all cases of paraphimosis that require more than minimally invasive methods of reduction. Manual reduction Manual reduction is performed by placing both index fingers on the dorsal border of the penis behind the retracted prepuce and both thumbs on the end of the glans. The glans is pushed back through the prepuce with the help of constant thumb pressure while the index fingers pull the prepuce over the glans.

Osmotic method Substances with a high solute concentration can be used to osmotically draw out fluid from the edematous glans and foreskin prior to manual reduction. Granulated sugar spread over the glans and foreskin for 2 hours has been shown to facilitate manual reduction. Puncture method This method requires the use of a to gauge needle to puncture openings into the foreskin to allow edematous fluid to escape from the puncture sites during manual compression. Successful reductions have been reported with single and up to 20 punctures.

It is thought that hyaluronidase disperses extracellular edema by modifying the permeability of intercellular substance in connective tissue. The use of this method is contraindicated in those with the presence of infection or cancer, since the technique may result in the spread of bacteria or malignant cells.


Drawbacks to this method include the risk of anaphylaxis and shock and the lack of availability of hyaluronidase in many EDs. Aspiration A tourniquet is applied to the shaft of the penis. A gauge needle is then used to aspirate mL of blood from the glans, parallel to the urethra. This reduces the volume of the glans sufficiently to facilitate manual reduction.

Vertical incision If none of the above methods are successful, the constricting band of the foreskin should be incised using a cm longitudinal incision between two straight hemostats placed in the o’clock position for hemostasis. Emergent circumcision This is a last resort, to be performed by a urologist, to achieve the necessary reduction of a paraphimosis.

Consultations A paraphimosis is a urologic emergency and prompt efforts to reduce the paraphimosis must be made by the emergency physician. If minimally invasive measures fail to reduce the paraphimosis, a urologic consultation is required. The ED physician may choose to recommend 0.

The urologist, in consultation with the patient and his family, may try a course of topical steroids or preputioplasty. A paraphimosis that is reduced with minimal intervention by the ED physician still requires outpatient urology follow-up in anticipation of recurrences and evaluation for possible circumcision.

Recurrence Posthitis Necrosis and gangrene of the glans[4] Autoamputation Prognosis Complete resolution is expected with appropriate treatment. Patient Education Parents should be educated about the normalcy of congenital phimosis and the time course of its resolution. The dangers of forcibly retracting the foreskin for hygienic purposes should be stressed.

If the prepuce does not readily retract, parents should not attempt to clean under it. Patients and parents of children should be educated on the importance of reduction of the foreskin after each cleaning. All providers of adult care should be made aware of the risk of paraphimosis associated with bladder catheterization. They should be reminded to always reduce the foreskin after cleaning and catheterization.

For excellent patient education resources, visit eMedicine’s Men’s Health Center. Also, see eMedicine’s patient education articles Foreskin Problems and Circumcision. Terjemahan Latar belakang Phimosis mengacu pada ketidakmampuan untuk menarik kembali kulup lebih distal glans penis.

Fimosis fisiologis terjadi secara alami pada laki-laki baru lahir.

Patologis phimosis mendefinisikan ketidakmampuan untuk menarik kembali kulup setelah sebelumnya yg dpt dibatalkan atau setelah pubertas, biasanya sekunder terhadap distal parut pada kulup. Parafimosis adalah jebakan dari kulup ditarik balik sulkus koronal.

Parafimosis adalah penyakit laki-laki disunat atau sebagian disunat. Fisiologis phimosis hasil dari adhesi antara lapisan epitel dari kulit khatan bagian dalam dan kelenjar. Ini adhesi secara spontan larut dengan pencabutan kulup intermiten dan ereksi, sehingga sebagai laki-laki tumbuh, fimosis fisiologis menyelesaikan dengan usia. Miskin kebersihan dan episode berulang balanitis atau memimpin balanoposthitis luka parut dari lubang preputial, menyebabkan phimosis patologis.

Pencabutan kuat dari kulup menyebabkan microtears di lubang preputial yang juga menyebabkan jaringan parut dan phimosis. Orang-orang tua beresiko phimosis sekunder untuk hilangnya elastisitas kulit dan ereksi jarang. Tindikan penis meningkatkan risiko mengembangkan parafimosis jika nyeri dan pembengkakan mencegah pengurangan dari kulup ditarik. Dengan waktu, gangguan aliran vena dan limfatik ke kelenjar menyebabkan pembengkakan vena dan pembengkakan memburuk.

Satu sampai lima persen laki-laki akan memiliki kulit khatan nonretractible pada usia paraifmosis tahun [1, 2]. Ras Tidak ada predileksi ras dikenal ada untuk fimosis dan parafimosis. Seks Fimosis dan parafimosis fimlsis laki-laki saja. Usia Fimosis dan parafimosis dapat terjadi pada semua usia.

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