уход за половыми органами мальчика

[internet]

Здравствуйте, моему сыну 2, 5 года. Хирург сказал раз в неделю открывать и тут же закрывать головку (что у меня не всегда получается), и периодически промывать с помощью шприца р-ом фурацелина, а сын не дается ни мне ни мужу. Что делать, на сильно открывать, промывать? воспалений никаких нет.

[pankovad]

Надо откравать не раз в неделю, а каждый день! и промывать с мылом. Если не видна венечная борозда, то нужно открывать головку и постепенно натягивать крайнюю плоть, что бы та постепенно отрывалась от головки, промывать фурациллином не надо! эффекта ни какого, просто иойте каждый день!

[BBC]

До той поры, пока доктор pankovad не подтвердит свои рекомендации ссылкой на приемлемый источник информации, прошу не принимать их всерьез.

[Gallen]

Совершенно непонятные рекомендации.

[pankovad]

Можно почитать в учебнике Ю.Ф. Исаков "Детская хирургия" в разделе фимоз, там написано, что недостаточно тщательный туалет наружных половых органов у мальчиков первых лет жизни может привести к развитию баланопостита.

[Melnichenko]

Осталось узнать критерии тщательности и прочесть о фимозе остальное

[Hogan]

Сообщение от pankovad

Можно почитать в учебнике Ю.Ф. Исаков "Детская хирургия" в разделе фимоз, там написано, что недостаточно тщательный туалет наружных половых органов у мальчиков первых лет жизни может привести к развитию баланопостита.

А можно почитать [Ссылки доступны только зарегистрированным пользователям ]

2. PHIMOSIS
2.1 Background
At the end of the first year of life, retraction of the foreskin behind the glandular sulcus is possible in only about 50% of boys; this rises to approximately 89% by the age of 3 years. The incidence of phimosis is 8% in 6- to 7-year-olds and just 1% in males aged 16-18 years (1). The phimosis is either primary (physiological) with no sign of scarring, or secondary(pathological) to a scarring such as balanitis xerotica obliterans. Phimosis has to be distinguished from normal agglutination of the foreskin to the glans, which is a physiological phenomenon (2).
The paraphimosis must be regarded as an emergency situation: retraction of a too narrow prepuce behind the glans penis into the glanular sulcus may constrict the shaft and lead to oedema. It interferes with perfusion distally from the constrictive ring and brings a risk of consecutive necrosis.

2.2 Diagnosis
The diagnosis of phimosis and paraphimosis is made by physical examination.
If the prepuce is not retractable or only partly retractable and shows a constrictive ring on drawing back over the glans penis, a disproportion between the width of the foreskin and the diameter of the glans penis has to be assumed. In addition to the constricted foreskin, there may be adhesions between the inner surface of the prepuce and the glanular epithelium and/or a fraenulum breve. A fraenulum breve leads to a ventral deviation of the glans once the foreskin is retracted. If the tip remains narrow and glanular adhesions were separated, than the space is filled with urine during voiding causing the foreskin to balloon outward.
The paraphimosis is characterized by retracted foreskin with the constrictive ring localized at the level of the sulcus, which prevents replacement of the foreskin over the glans.

2.3 Treatment
Treatment of phimosis in children is dependent on the parents’ preferences and can be plastic or radical circumcision after completion of the second year of life. Plastic circumcision has the objective of achieving a wide foreskin circumference with full retractability, while the foreskin is preserved (dorsal incision, partial circumcision). However, this procedure carries the potential for recurrence of the phimosis. In the same session, adhesions are released and an associated fraenulum breve is corrected by fraenulotomy. Meatoplasty is added if necessary.
An absolute indication for circumcision is secondary phimosis. The indications in primary phimosis are recurrent balanoposthitis and recurrent urinary tract infections in patients with urinary tract abnormalities (3-6) (level of evidence: 2, grade B recommendation). Simple ballooning of the foreskin during micturition is not a strict indication for circumcision.
Routine neonatal circumcision to prevent penile carcinoma is not indicated. Contraindications for circumcision are coagulopathy, an acute local infection and congenital anomalies of the penis, particularly hypospadias or buried penis, because the foreskin may be required for a reconstructive procedure (7,8).
Childhood circumcision has an appreciable morbidity and should not be recommended without a medical reason (9-12) (level of evidence: 2, grade B recommendation). As a conservative treatment option of the primary phimosis, a corticoid ointment or cream (0.05-0.1%) can be administered twice a day over a period of 20-30 days (13-16) (level of evidence: 1, grade A recommendation). This treatment has no side effects and the mean bloodspot cortisol levels are not significantly different from an untreated group of patients (17) (level of evidence: 1). Agglutination of the foreskin does not respond to steroid treatment (14) (level of evidence: 2).
Treatment of paraphimosis consists of manual compression of the oedematous tissue with a subsequent attempt to retract the tightened foreskin over the glans penis. Injection of hyaluronidase beneath the narrow band may be helpful to release it (18) (level of evidence: 4, grade C recommendation). If this manoeuvre fails, a dorsal incision of the constrictive ring is required. Depending on the local findings, a circumcision is carried out immediately or can be performed in a second session.