Проблема крайньої плоті у дітей

Abstract

Оглянуто 826 хлопчиків віком від 10 діб до 16 років. У 555 дітей стан крайньої плоті не потребував хірургічного лікування. У 63 дітей виявлено рубцевий фімоз, 208 дітей зверталися в екстреному порядку з явищами гострого баланопоститу. З оглянутих дітей 276 перенесли одномоментне виведення голівки статевого члена, з них у 70 дітей виникли ускладнення у вигляді гострого баланопоститу, рефлекторної затримки сечі, парафімозу. 439 дітям з фізіологічним фімозом та гіпертрофованою крайньою плоттю була рекомендована методика поступового виведення голівки, яка була ефективна в 412 випадках; . Осмотрено 826 мальчиков в возрасте от 10 суток до 16 лет. У 555 детей состояние крайней плоти не требовало хирургического лечения. У 63 детей выявлен рубцовый фимоз, 208 детей обращались в экстренном порядке с явлениями острого баланопостита. Из осмотренных детей 276 перенесли одномоментное выведение головки полового члена, из них у 70 детей возникли осложнения в виде острого баланопостита, рефлекторной задержки мочи, парафимоза. 439 детям с физиологическим фимозом и гипертрофированной крайней плотью была рекомендована методика постепенного выведения головки, которая была эффективна в 412 случаях; The pathology of the prepuce in children has a big number of agespecific features. Considerable interest of parents and wide range of doctors (children and adults surgeons, urologists, pediatricians, family physicians) in contact with the pathology of the prepuce, the total lack of tactics, a large number of complications and adverse effects of some manipulations determine the relation of prepuce in children as a problem. According to the literature, the surface of the head and the inner layer of the foreskin in a state of “epithelial bonding“, which is physiological for children. The production of smegma begins at birth or from 3- 4th month of life and is also a natural process. Fragments of smegma gradually migrate to the top of the glans penis and are separated, leading to natural cleaning the prepuce and slow separation of synechia. Thus, the presence of smegma and synechia in prepubertatic period (11 - 15 years) is considered normal . On the base of children's surgical department of the Poltava Children's Clinical Hospital during the period from 2003 to 2013 826 boys were examined aged from 10 days to 16 years, 618 of them by the outpatient reception. 208 children treated on an emergency basis with symptoms of acute balanoposthitis, one among 70 boys were executed on the eve of one-stage forced the withdrawal of the glans penis. In 480 boys with physiological phimosis, surgical treatment was unnecessary. In 75 children identified hypertrophied prepuce without evidence of urination disorders. In 63 children revealed cicatricial phimosis, they recommended surgical treatment. Children with symptoms of acute balanoposthitis appointed bath without active surgical manipulation. After the elimination of the inflammation the reexamination intended to determine the state of the prepuce. In children who underwent one-stage forced exposure of the glance penis, psychological trauma noted in almost 100 % of patients. Painful manipulation and its aftermath in children caused sharply negative attitude toward re-examination of the doctor and their attempts to reexposure to the glance penis. All children had radial cracks and breaks of prepuce. In 21 infants were also seen complaints on general anxiety, sleep disturbances, fever. The 26 was recorded natural acute urinary retention reflex. Attempts of parent to bring the glance of the penis under the conditions of swelling of the prepuce in 8 boys caused the phenomina of paraphimosis that require reposition the head. Children older than 3 years with physiological phimosis and hypertrophied prepuce was recommended method of progressive sparing output of the glance penis, which was effective in 412cases. Thus, the presence of synechiae and smegma in preputsial bag with no signs of inflammation and urination disorders does not require active surgical manipulations. Method of simultaneous exposure of violent head is traumatic and has a lot of complications and adverse effects. Children older than 3 years with physiological phimosis of prepuce and hypertrophied one is recommended method of progressive sparing output of the glance penis.