An epispadias represents a congenital urogenital anomaly in which the external aperture of the urethra is located on the dorsal-upper side of the penis. The anomaly is characterised by existing of the wide-gapping plate on the upper side of the penile body, while an excess of skin is located on the lower side, covering the glans penis. Often the incontinence-impossibility of retaining the urine is developed, and the most common combined anomalies are cryptorchidism (undescended testicles) and generation of an inguinal hernia. In the adult persons, sexual relations are practically impossible, as the penis is pressed against the anterior abdominal wall. It is rare in women, and is manifested by a short split urethra and a bifid clitoris. Epispadias is often combined with the bladder extrophy. An optimal time for surgical correction is around 2 years of age. A surgical treatment implies a correction of the penile curvature, reconstruction of the missing part of the urethra and achieving of the normal appearance of the external genitals. A full reconstruction of all the parts of the penis is required, along with solving the incontinence problem.
A curved penis is a very common phenomenon and it can be congenital or acquired. It can occur anywhere on the penile body and turn it in every direction. A congenital curvature of the penis can be downside/oriented and is caused by the scar tissue located under the penis surface, or it can be lateral to the left or to the right, caused by an uneven length of the erectile penile bodies. The acquired penile curvature is caused by the disease called the PEYRONIE DISEASE, and results in creation of scar tissue on the very penile bodies.
During erection, the scar tissue limits the extension of this part of the penis, and by that causes the bending of the penis to one side.A surgical technique of treating this problem implies placing of certain sutures alongside the penile body, in order for the genital organ to retreat to the side which is opposite to the curve. This method can sometimes cause mild shortening of the penis, and s therefore often combined with the technique of enlargement of the genital organ.
Phimosis A phimosis is a difficult or fully enabled pulling the foreskin over the glans penis, and the disease can be congenital or acquired. The glans penis cannot be liberated – sometimes only in erection, and sometimes in the loose state as well. Besides, there is a situation when the frenulum on the lower side of the glans penis is short, and at pulling the foreskin, this frenulum pulls the glans penis downwards and creates pain, interfering with normal sexual intercourse. The frenulum often breaks, which creates painful sores which heal with difficulty, and when they do, the frenulum can become even shorter. The acquired phimosis can occur due to scarring and narrowing of the preputium after the inflammation processes or due to the oedema after the acute inflammation.
Due to the excess skin, there is a urine blockade, smegma secretion and secondary infection, which leads to chronic irritation. Circumcision is a surgical technique by which an excess skin is removed partially or in whole, and is performed in local anaesthesia. Paraphimosis is a condition in which the foreskin cannot be pulled back over the glans penis and cover it, but it remains under the glans penis and tights it firmly causing pain and swelling, and in a long-lasting one even a gangrene. Paraphimosis occurs most often after masturbation or sexual intercourse, while the penis is still erected, and it can happen in children (although rarely), e.g. at maintaining hygiene or forced pulling over the foreskin. The objective of the surgical intervention is to cut the foreskin and to free the glans penis. If there is gangrene, a radical circumcision of the foreskin is required.