Фимоз?

[Anakonda]

Здравствуйте. Моему сыну 7 лет 9 месяцев. У него не открывается головка, только чуть-чуть, примерно раскрывается миллиметров на пять, а дальше ему больно. Знаю, что это у маленьких детей физиологически обусловлено,но, не знаю, до какого возраста это нормально. Следует ли уже обратитьс к врачу? Или такие проблемы нужно решать в возросте полового созревания?
Заранее спасибо.

[AlUrS]

Обычно у детей к 3 годам головка открывается. Посетите детского уролога.

At birth, there is normally a physiologic phimosis or inability to retract the foreskin because natural adhesions exist between the prepuce and the glans. During the first 3 to 4 years of life, as the penis grows, epithelial debris (smegma) accumulates under the prepuce, gradually separating the foreskin from the glans. Intermittent penile erections cause the foreskin to become completely retractable. By 3 years of age, 90% of foreskins can be retracted, and less than 1% of males have phimosis by 17 years of age (Oster, 1968 ).
Early forceful retraction of the foreskin generally is not recommended because recurrent adhesions between the de-epithelialized glans and foreskin may occur, and a cicatrix may form at the tip of the foreskin, causing secondary phimosis. However, in boys older than 4 or 5 years and in those whodevelop balanitis or balanoposthitis, application of a topical corticosteroid cream (e.g., 0.1% triamcinolone) to the foreskin three or four times daily for 6 weeks loosens the phimotic ring in 70% to 80% of cases and usually allows the foreskin to be retracted manually ( Yang et al, 2005 ). This effect is durable, but if phimosis recurs, another course of steroid cream is generally effective ( Lund et al, 2005 ). In older boys with phimosis, balanitis xerotica obliterans is common, affecting approximately 40% ( Kiss et al, 2005 ). Topical corticosteroids are beneficial even if the foreskin is involved with balanitis xerotica obliterans ( Kiss et al, 2001 ). Formal lysis of adhesions is rarely indicated. In uncircumcised boys older than 7 or 8 years with phimosis that is resistant to topical corticosteroids and in boys with phimosis that causes ballooning of the foreskin or recurrent balanitis, strong consideration should be given to circumcision. An alternative to circumcision is preputioplasty ( Dean et al, 2000 ), which can be performed under local anesthesia ( Dessanti et al, 2005 ).

Wein: Campbell-Walsh Urology, 9th ed