Pediatric andrology. When to see a doctor: Part 1 – balanoposthitis, phimosis

Relatively recently, pediatric andrology was a science known only to a very narrow circle of specialists, and was "in the shadow" of a major area of pediatric surgery – urology. Today, these disciplines are combined into a common specialty called pediatric urology-andrology.
 
Pediatric andrology is a branch of medicine that studies the development, health status and diseases of the organs of the male reproductive system of a child from the moment they are in the womb to puberty. Its task is to preserve the health of boys and adolescent boys in order for them to carry out the function of procreation in adulthood in full. In modern society, the problem of male infertility has become extremely urgent, the causes of which are mainly laid in childhood, therefore timely diagnosis and treatment of diseases are the key to the health of a future man and his ability to have children.
 
Today, not many pediatric surgeons have the additional qualifications of an andrologist-urologist. To purchase it, the doctor must undergo special training and receive a state-issued certificate. After all, andrology, like any surgical specialty, is associated with special responsibility and increased risk. Unqualified actions in andrology can cause complications and chronicity of many diseases.
 
Children are characterized by a number of diseases that directly affect the condition of the reproductive organs: balanoposthitis, orchitis, phimosis, cryptorchidism, varicocele, hydrocele, hypospadias and many others. All these ailments not only cause suffering to the child, but can also cause irreversible infertility in the future.

Studies have shown that prostatitis, which is widespread in adult men, is very often the result of balanoposthitis that was not cured in childhood. These are inflammatory diseases of the foreskin and prepuce sac (the space between the head of the penis and the foreskin). In most cases, inflammation of the foreskin (balanitis) It is combined with inflammation of the glans penis (postures).
 
In children, such inflammations are most often acute and manifest themselves in a pronounced form – there is redness, swelling of the foreskin, pain, accumulation under the skin and discharge of pus. When an infection enters the urethra and inflames it, urethritis develops, which causes pain when urinating. Repeated acute inflammation of the foreskin, periodic itching and pain when urinating may indicate the chronicity of the disease. Chronic balanoposthitis is very dangerous, as it can lead to prostatitis in adults. In this case, the infection can rise along the vas deferens and cause inflammation of the epididymis appendage, followed by infertility.
 
All boys with inflammatory processes in the foreskin should be consulted by a pediatric andrologist-urologist, who will diagnose and begin treatment not only of local inflammatory processes, but also of the very cause of the disease using the most effective and least traumatic method for the child.

Phimosis, or narrowing of the outer opening of the foreskin, in which the glans penis cannot be exposed, is one of the most common malformations that can cause repeated inflammation of the foreskin. Phimosis occurs in 5-7% of boys, it can be congenital or acquired.
 
It is worth noting that in most children under 4 years of age, congenital narrowing of the foreskin is observed as a physiological phenomenon, i.e. it does not need treatment in the absence of manifestations of inflammation. Hypertrophic phimosis is an excessive, inelastic foreskin that does not allow the head to be removed, one of the congenital forms of the disease. Acquired phimosis can develop due to inflammation, or as a result of damage to the foreskin and unsuccessful wound healing. A typical lesion of the foreskin, followed by scarring and the formation of cicatricial phimosis, occurs when a traumatic attempt is made to remove the glans penis of a child independently or not by specialists.
 
Parents of children with phimosis often come to our clinic to see an andrologist urologist due to frequent inflammation of the flesh. Sometimes children have soreness and discomfort when urinating.  It happens that it is difficult for a child to urinate, when urinating, urine is released in a thin stream, and the foreskin swells like a "ball". Difficulty urinating with phimosis can lead to pyelonephritis and hydronephrosis (enlargement of the renal pelvis). With a very narrow opening of the foreskin, and when it is removed by a non–specialist, it is possible to pinch the glans penis - paraphimosis.
 
If a child has a narrowing of the foreskin or has difficulty urinating, it is necessary to show the boy to a pediatric specialist.  Surgical intervention is recommended for phimosis. Conservative methods of treatment do not justify themselves. The surgery of choice for phimosis is excision of the foreskin, better known as circumcision (circumcision). According to statistics, about half of the male population of the Earth underwent this operation for ritual, religious or medical reasons. However, circumcision is not so common in European culture. In this regard, the andrologist surgeon at the EMC Children's Clinic has modern, gentle foreskin surgery, which in some cases allows you to preserve the usual appearance of the penis.