Phimosis Treatment Questions and Answers for Doctors and Patients

Reference:

Van Howe, R. S. (2015). Functions of the Foreskin. The Annals of Family Medicine, 13(5), 465–468. doi: 10.1370/afm.1867

What is adult male phimosis and how does it arise?

Adult male phimosis is a condition where the foreskin of the penis is too tight to be retracted over the glans penis, the head of the penis. This can cause discomfort, pain, and difficulty during sexual intercourse and may require medical attention.

Phimosis can arise due to a variety of reasons, including poor hygiene, chronic inflammation, scarring from injury, and infections. It can also be a result of a genetic predisposition or a side effect of certain medical treatments.

Reference:

Van Howe, R. S. (2018). Adult phimosis: indications for circumcision. Translational andrology and urology, 7(Suppl 1), S63–S67. doi:10.21037/tau.2018.01.08

In the Australian clinical context what are the current treatment guidelines for adult male phimosis?

In the Australian clinical context, the current treatment guidelines have not been written fopr adults and are considered out of date based on a contemproary litertaure review. Treatment for adult male phimosis depend on the severity of the condition. For mild to moderate cases, topical steroid creams may be recommended to reduce inflammation and promote foreskin elasticity. For more severe cases, circumcision or preputioplasty (a surgical procedure to widen the foreskin) may be necessary. Balloon dilatation has now been established in the literature and clinical trails and practice. This is a safe and effective treatment that should be included in the clinical treatment guidleines for phimosis/ 

Reference:

The Royal Australasian College of Physicians. (2016). Male circumcision. Retrieved fromhttps://www.racp.edu.au/docs/default-source/advocacy-library/male-circumcision.pdf

Gross, M. S., Phillips, E. A., Carrasquillo, R. J., & Thornton, A. (2019). The "home-based" foreskin balloon dilation procedure: a less invasive treatment option for phimosis. Translational andrology and urology, 8(Suppl 1), S29–S34. doi: 10.21037/tau.2019.03.20.

How effective and safe are topical steroids used for treating male adult phimosis?

Topical steroids have been shown to be an effective and safe treatment option for male adult phimosis, particularly in mild to moderate cases. They work by reducing inflammation and promoting foreskin elasticity, allowing the foreskin to be retracted more easily.

A systematic review and meta-analysis of 14 randomized controlled trials found that topical steroids were significantly more effective than placebo in treating phimosis, with a success rate of 79.8% compared to 22.2% for placebo. The review also found that topical steroids were generally safe and well-tolerated, with no serious adverse effects reported.

Topical steroids are generally considered safe and well-tolerated when used to treat adult male phimosis. However, as with all medications, they can cause side effects in some individuals.

Reported side effects of topical steroids used for phimosis include skin irritation, burning, itching, and redness at the application site. In rare cases, prolonged use of topical steroids may lead to skin thinning, discoloration, or stretch marks. It is important to use topical steroids as directed by a healthcare provider and to monitor for any signs of adverse effects.

Reference:

Yang, S., Gao, L., & Zhou, J. (2017). Topical steroid therapy for phimosis in boys. American Journal of Therapeutics, 24(6), e727–e732. doi: 10.1097/MJT.0000000000000413.

What is adult circumcision surgery? What are the adverse events, side effects and negative consequences of circumcision in men, especially related to sexual function and enjoyment?

Adult circumcision surgery involves the removal of the foreskin of the penis. The procedure is typically performed under local or general anesthesia and may be recommended for the treatment of phimosis, balanitis, or other medical conditions.

Adverse events and side effects of adult circumcision surgery can include bleeding, infection, pain, swelling, and bruising. In rare cases, more serious complications such as excessive bleeding, hematoma, and penile injury may occur.

Regarding sexual function and enjoyment, studies have produced conflicting results. Some studies have suggested that circumcision may lead to decreased sensitivity and pleasure during sexual activity, while others have found no significant difference or even a potential increase in sexual satisfaction. However, it should be noted that these studies are often limited by small sample sizes, and individual experiences may vary.

Reference:

Morris, B. J., & Krieger, J. N. (2017). Does male circumcision affect sexual function, sensitivity, or satisfaction?—A systematic review. The Journal of Sexual Medicine, 14(11), 1376-1393. doi: 10.1016/j.jsxm.2017.08.015.

Balloon-based foreskin tissue expansion is a non-surgical method of treating adult male phimosis. The procedure involves inserting a small balloon into the foreskin and inflating it with saline solution (patented Novoglan balloon does not require saline solution as the revolutionary balloon technology allows for air to exert sufficient pressure to create the required level of stretch), which gradually stretches and expands the foreskin over time.

The process of balloon-based tissue expansion stimulates the growth of new tissue and promotes foreskin elasticity, allowing it to be retracted more easily. The procedure is minimally invasive and can typically be performed in an outpatient setting with local anesthesia.

Reference:

Pieretti RV, Goldstein AT, Pieretti-Vanmarcke R, Zavaski M, Eid JF. (2015). Ballooning technique for foreskin dilation: a stepwise approach to avoid complications. Urology, 85(5):1108-12. doi: 10.1016/j.urology.2015.02.004.

What advantages does the non surgical balloon based foreskin tissue expansion technique have over circumcision surgery or topical steroids have in the treatment of phimosis?

The non-surgical balloon-based foreskin tissue expansion technique has several advantages over circumcision surgery and topical steroids in the treatment of phimosis.

Compared to circumcision surgery, balloon-based tissue expansion is less invasive, has a shorter recovery time, and preserves the natural appearance and function of the penis. It also avoids the potential risks and negative consequences of circumcision, such as pain, bleeding, infection, and decreased sexual function.

Compared to topical steroids, balloon-based tissue expansion is a more targeted and effective treatment option for phimosis. It is also associated with fewer side effects and does not require prolonged use or daily application.

Reference:

Kim, H. Y., Yang, D. Y., Lee, Y. S., Chung, J. H., Lee, J. Y., & Lee, S. D. (2019). The efficacy and safety of a novel device for non-surgical foreskin expansion and the indication for the treatment of phimosis. Investigative and clinical urology, 60(1), 59–64. doi: 10.4111/icu.2019.60.1.59.

Describe the medical and ethical principles that support the recommendation to change the clinical treatment guidelines for adult male phimosis from either topical steroid and circumcision to include non surgical balloon based foreskin tissue expander for use at home?

The medical and ethical principles that support the recommendation to change the clinical treatment guidelines for adult male phimosis to include non-surgical balloon-based foreskin tissue expander for home use are based on the principles of patient autonomy, non-maleficence, beneficence, and justice.

Patient autonomy: The use of non-surgical balloon-based foreskin tissue expander allows patients to have greater control over their treatment and to choose a less invasive option that avoids potential risks and negative consequences of circumcision.

Non-maleficence: Non-surgical balloon-based foreskin tissue expander is a safe and effective treatment option that avoids the potential harms associated with circumcision, such as pain, bleeding, and infection.

Beneficence: Non-surgical balloon-based foreskin tissue expander is an effective treatment option that promotes patient well-being and improves quality of life by providing an alternative to circumcision and avoiding the negative consequences of phimosis.

Justice: Non-surgical balloon-based foreskin tissue expander is a cost-effective and accessible treatment option that can be used at home, making it a more equitable option for patients who may not have access to specialized medical care or surgical facilities.

Reference:

Gross, M. S., Phillips, E. A., Carrasquillo, R. J., & Thornton, A. (2019). The “home-based” foreskin balloon dilation procedure: a less invasive treatment option for phimosis. Translational andrology and urology, 8(Suppl 1), S29–S34. doi: 10.21037/tau.2019.03.20.

Can penile scarring and discoloration due to circumcision cause mental health issues for men?

Penile scarring and discoloration due to circumcision can potentially have negative psychological effects on men. Some men may experience anxiety, depression, or negative body image due to the appearance of their penis after circumcision. This may be particularly true in cases where the circumcision was performed without the individual's informed consent or resulted in complications or adverse effects.

Research has found a significant association between circumcision and negative psychological outcomes, including anxiety and depression. However, it should be noted that the relationship between circumcision and psychological health is complex, and individual experiences may vary.

It is important for healthcare providers to consider the potential psychological impacts of circumcision and to provide appropriate support and counseling for patients who may be experiencing distress related to their circumcision status.

Reference:

Boyle, G. J., Svoboda, J. S., Price, C. P., & Turner, J. N. (2000). Circumcision of healthy boys: Criminal assault? Journal of Law and Medicine, 8(1), 1-28.

 What is the typical cost for patients in Australia, Canada, UK and USA of circumcision surgery in a private clinic, including all related consultations?

The cost of circumcision surgery can vary widely between countries and even between different regions within a country. However, I can provide a general idea of the typical cost of circumcision surgery in private clinics for the countries you have mentioned based on available sources:

• Australia: The cost of circumcision surgery in a private clinic in Australia is reported to range from AUD $700 to $2000, depending on the location and the clinic. (Source: HealthEngine)
• Canada: The cost of circumcision surgery in a private clinic in Canada is reported to range from CAD $300 to $800, depending on the location and the clinic. (Source: WhatClinic)
• UK: The cost of circumcision surgery in a private clinic in the UK is reported to range from £1,200 to £2,500, depending on the location and the clinic. (Source: Harley Street Health Centre)
• USA: The cost of circumcision surgery in a private clinic in the USA is reported to range from $1,500 to $4,000, depending on the location and the clinic. (Source: NewChoiceHealth)

It is important to note that the actual cost of circumcision surgery may vary depending on several factors, such as the extent of the procedure, the experience of the surgeon, and the anesthesia used.

References:

• HealthEngine. (n.d.). How much does circumcision cost in Australia? Retrieved fromhttps://healthengine.com.au/info/how-much-does-circumcision-cost-in-australia
• WhatClinic. (n.d.). Circumcision Canada. Retrieved fromhttps://www.whatclinic.com/urology/canada/circumcision
• Harley Street Health Centre. (n.d.). Circumcision. Retrieved fromhttps://www.harleystreethealthcentre.co.uk/circumcision
• NewChoiceHealth. (n.d.). Circumcision Cost and Procedure Introduction. Retrieved fromhttps://www.newchoicehealth.com/circumcision/cost

A comparison of the risk-benefit analysis between circumcision surgery and non-surgical balloon foreskin stretching treatments for adult phimosis depends on several factors, including the individual patient's medical history, preferences, and treatment goals. However, in general, balloon foreskin stretching treatments may have several advantages over circumcision surgery.

Benefits of balloon foreskin stretching:

• Non-invasive: Balloon foreskin stretching is a non-invasive and minimally painful procedure that can be performed at home.
• Preserves natural anatomy and function: Balloon foreskin stretching preserves the natural anatomy and function of the penis, including the foreskin and its sensory and protective functions.
• Cost-effective: Balloon foreskin stretching is a cost-effective alternative to circumcision surgery, which can be expensive and may not be covered by insurance.
• Fewer risks: Balloon foreskin stretching carries fewer risks of complications than circumcision surgery, which may include bleeding, infection, and decreased sexual function.

Drawbacks of balloon foreskin stretching:

• Treatment compliance: Balloon foreskin stretching requires a commitment to regular use (20 minutes per day) over a period of between two to 6 weeks to achieve effective results.
• Potential discomfort: Balloon foreskin stretching may, but rarely cause some discomfort during the initial stages of treatment, such as minor pain or irritation. This is mitigated by the user self controlling the stretch level.
• Not suitable for all cases: Balloon foreskin stretching may not be effective in all cases of phimosis, particularly in cases where scarring or other underlying conditions are present. (Recent abstract by Gillatt and Chung, demonstrates that the Novoglan balloon is effective against all grades of phimosis)

Overall, the decision between circumcision surgery and non-surgical balloon foreskin stretching treatments for adult phimosis requires careful consideration of the individual patient's needs and preferences, as well as consultation with a healthcare provider.

Reference:

Gross, M. S., Phillips, E. A., Carrasquillo, R. J., & Thornton, A. (2019). The "home-based" foreskin balloon dilation procedure: a less invasive treatment option for phimosis. Translational andrology and urology, 8(Suppl 1), S29–S34. doi: 10.21037/tau.2019.03.20.

The cost-benefit analysis of using the Novoglan Phimosis Treatment for adult male phimosis compared to circumcision surgery would depend on several factors, such as the severity of phimosis, individual patient preferences, and the location of the clinic or provider. However, in general, the Novoglan Phimosis Treatment may have cost advantages over circumcision surgery, as it is a non-invasive and cost-effective alternative.

The full cost of circumcision surgery for adult male phimosis in Australia, for example, can range from AUD $700 to $2,000 or more, depending on the clinic and location. In comparison, the Novoglan Phimosis Treatment costs AUD $240 for the full treatment, which includes the Novoglan Gentle Foreskin Stretcher and a supply of Novoglan Cream, as well as access to the online support program.

Therefore, the Novoglan Phimosis Treatment may be a more cost-effective treatment option for adult male phimosis than circumcision surgery, particularly for patients who may not have access to specialized medical care or insurance coverage.

Reference:

Platigo Solutions Pty Ltd.  Phimosis Treatment. Retrieved fromhttps://www.novoglan.com/phimosis-treatment/

Platigo Solutions Pty Ltd.  Novoglan Phimosis Treatment Kit Product Page https://store.novoglan.com/products/novoglan-non-surgical-phimosis-treatment-foreskin-expander-kit.html