Scientific management of phimosis, paraphimosis, and epididymitis: comprehensive protection of men's health.

Phimosis and Paraphimosis

The mushroom-shaped bulge at the tip of the penis is called the glans penis. Part of the penile skin folds over and covers the glans penis at the coronal sulcus, forming the foreskin. In normal men, the foreskin should cover the glans penis by one-third or above the coronal sulcus; that is, the entire glans or the lower two-thirds should be exposed outside the foreskin. If the foreskin completely covers the glans but can be retracted above the coronal sulcus, it is called paraphimosis. If it cannot be retracted or the foreskin has only a small opening, it is called phimosis.

The inner layer of the foreskin contains numerous sebaceous glands that constantly secrete a pale yellow, oily substance. This substance mixes with urine and shed epithelial cells to form smegma. Men with shorter foreskins have less chance of smegma formation, while men with paraphimosis can have a large amount of smegma, which can easily lead to local infections and penile cancer. Especially for patients with phimosis, smegma buildup is difficult to clean and remove, leading to long-term irritation of local tissues. The risk of infection and tumors is higher in these patients compared to those with redundant foreskin or normal foreskin. Therefore, circumcision should be performed as early as possible for patients with phimosis or redundant foreskin.

Delaying surgical treatment for phimosis or redundant foreskin has the following disadvantages:

① Frequent local tissue infections, leading to chronic balanitis.

② Repeated inflammation can cause adhesions between the foreskin and glans penis and the external urethral opening, narrowing the urethral opening and affecting urination.

③ In some patients with redundant foreskin, although the foreskin can be retracted and smegma can be frequently cleaned, the narrow foreskin opening makes retraction difficult. Sometimes, even after retraction, failure to reposition the foreskin promptly can cause local tissue edema, leading to paraphimosis. In severe cases, local tissue necrosis can occur, requiring emergency treatment at a hospital.

④ In men with phimosis, the glans penis is constantly covered by the foreskin, resulting in less contact with the outside world. This makes the nerve endings highly sensitive to various stimuli, increasing the risk of premature ejaculation in some patients.

⑤ Although men with phimosis can frequently retract the foreskin and wash away smegma, it is sometimes impossible to clean it completely. During sexual intercourse, residual smegma can be introduced into the woman's vagina, potentially irritating the cervix and leading to cervical cancer.

⑥ Some men with paraphimosis have a very small opening, like a pinhole, making urination difficult each time. Over time, this can increase bladder pressure and cause hypertrophy of the detrusor muscle. Increased bladder pressure can directly affect kidney function, potentially leading to post-renal renal insufficiency and impacting health.

⑦ The incidence of penile cancer is several times higher in men with phimosis and redundant foreskin compared to those with normal foreskin.

Therefore, patients with phimosis or redundant foreskin should seek surgical treatment at a hospital as soon as possible. Especially for those with phimosis causing difficulty urinating, surgical treatment should be performed as soon as possible; otherwise, prolonged phimosis can affect bladder and kidney function. For some patients with phimosis who cannot undergo surgery, the foreskin should be regularly retracted and cleaned with warm water to avoid the harmful effects of smegma.

Acute Epididymitis

The epididymis is a pair of slender, flat tissues located behind the testis and closely connected to it. The enlarged and blunt part at the upper end of the testis is called the head of the epididymis, and the slightly smaller part at the lower end is called the tail of the epididymis. The slender part between the head and tail is called the body of the epididymis. Many teenagers lacking medical knowledge, upon accidentally feeling a lump on their testis, mistakenly believe they have a testicular tumor and become very frightened. In fact, the lump is epididymal tissue, and there is no need to panic. If you have any doubts, you can go to the hospital for a specialist examination and diagnosis. Because the epididymis and testis are closely connected, sometimes both the epididymis and testis become infected simultaneously, a condition known as epididymo-orchitis.

1. Incidence of Epididymitis

Epididymitis can occur from newborns to the elderly, with the highest incidence between 19 and 35 years of age. The incidence is slightly lower in middle-aged and elderly individuals.

2. Causes

① Direct bacterial infection of the urogenital tract. Examples include prostatitis, urethritis, and seminal vesiculitis. Generally, pathogenic microorganisms enter the epididymis through the lumen of the vas deferens; some believe it occurs through the lymphatic system.

② Infections from other parts of the body can enter the epididymal tissue via the bloodstream, causing epididymitis. Examples include tonsillitis, dental infections, pneumonia, and colds. Systemic infections can carry pathogens (viruses) into the epididymis via the bloodstream, causing epididymitis.

③ Testicular and epididymal trauma. Trauma can cause local circulatory disturbances, reducing local resistance and potentially inducing epididymitis, although this is relatively rare.

④ Catheterization and urethral instrumentation can damage the urethral mucosa, creating a bacterial infection focus that can ascend into the epididymis and cause infection.

⑤ The main pathogens causing epididymitis are Escherichia coli, Proteus, Staphylococcus, Enterococcus, and Pseudomonas aeruginosa.

3. Clinical Manifestations

① Symptoms: Sudden onset, developing into acute inflammation within hours. Patients experience testicular swelling and discomfort, which may radiate to the groin. The affected scrotum is enlarged, and body temperature rises, sometimes reaching 40°C.

② Signs: Scrotal redness and swelling, increased skin temperature, enlarged and tender inguinal lymph nodes on the affected side. In the early stages, the enlarged epididymis and testis may have a clear boundary, but the testis is quickly affected and merges with the enlarged epididymis, becoming significantly tender. The total white blood cell count in peripheral blood is significantly elevated.

4. Treatment

① General Treatment: During the acute phase, bed rest is recommended. Elevating the drooping scrotum can alleviate pain. Cold compresses can be applied locally in the early stages to reduce tissue swelling, while warm compresses can be applied in the later stages to promote inflammation absorption. Sexual activity should be avoided.

② Antibiotic Treatment: Any antibiotic effective against Gram-negative bacilli can be used, administered orally, intramuscularly, or intravenously, such as ampicillin, cephalosporins, and spiramycin.

a. Ampicillin 1.0–2.0g, twice daily via intramuscular injection or intravenous infusion for 5–7 days.

b. Spiramycin 200 mg, three times daily, orally for one week.

c. For patients without a history of sulfonamide allergy, compound sulfamethoxazole 1.0g can be taken orally twice daily for 1–2 weeks.

③ Surgical Treatment: Most patients recover quickly with antibiotic treatment. A small number may develop abscesses. For these patients, incision and drainage of the epididymal abscess can be performed. Epididymis with uncontrollable infection should be removed.

5. Prognosis

Acute epididymitis usually resolves quickly with timely and effective treatment, with symptoms and pain disappearing in about 1-2 weeks. However, it takes more than 4 weeks for the enlarged epididymis to return to its pre-illness state. A small number of patients may develop chronic epididymitis due to improper treatment.

Chronic epididymitis generally has no other serious consequences besides local pain and discomfort, but bilateral chronic epididymitis may affect fertility.