¿Qué es la fimosis?


La fimosis es un problema  de los varones, que ocurre cuando el prepucio no puede ser retraído por detrás del surco del glande o cabeza del pene. Si quieres saber más sobre la fimosis, puedes leer este post.

El prepucio es la porción de piel que cubre el cuerpo peneano y el glande, cumpliendo entre otras funciones la de protección.
 
¿CUÁNDO APARAECE LA FIMOSIS?
La fimosis puede estar presentes desde el momento de nacer. A medida que el niño crece, se irá produciendo la separación gradual del prepucio. Mientras ocurre el proceso de desprendimiento pueden presentarse complicaciones como; infección del tracto urinario, balanitis o parafimosis . Habitualmente es posible conseguir su retracción completa en estado de flacidez y/o erección entre los 12 y 14 años. De esta forma podemos decir que un prepucio sano debería poder retraerse completamente, quedando el glande totalmente al descubierto durante una erección, sin molestias ni dolor.
Cuando la fimosis aparece en la edad adulta, hablamos de Fimosis Adquirida o de nueva aparición. Existe una serie  de factores predisponentes.
 
CAUSAS  Y FACTOES PREDISPONENTES DE FIMOSIS EN EDAD ADULTA

  • Falta de higiene adecuada.
  • Balanitis: Es una infección de la mucosa que recubre el prepucio y el glande (espacio balanoprepucial) debido principalmente a una higiene deficiente de la zona.
  • La postitis o inflamación e infección del prepucio.
  • La balanopostitis o unión de las patologías anteriormente mencionadas. Estas entidades se encuentran íntimamente relacionadas con la fimosis. La presencia de ésta provoca aumento en la incidencia de dichas infecciones, y predispone al acúmulo de sustancias secretadas y a la colonización de bacterias, hongos y virus en el interior del prepucio.
  • Enfermedades dermatológicas
  • Los varones diabéticos debido a su predisposición a padecer balanitis y xerosítis
  • Tumores
  • Fimosis durante la infancia que no fue tratada a tiempo, con empeoramiento durante la edad adulta.

 
¿QUE SíNTOMAS PRESENTA?
En el caso de los niños:

  • Puede no tener síntomas. A veces se trata de hallazgos causales, que provocan preocupación y consulta al pediatra de referenciÍa.
  • En otras ocasiones puede existir dolor en la micción, infecciones en el pene de forma repetida por la acumulación  de secreciones.
  • Irritación local
  • Dificultad para orinar.

En personas jóvenes y Adultos:

  • Los síntomas pueden ser similares a los de la infancia.
  • Dolor en la erección y cuando se mantiene relaciones sexuales.
  • Sensación de tensión durante la erección.
  • Inflamación del prepucio durante la micción.
  • Dificultad en la micción en casos severos pudiendo provocar retenciones de orina (RAO)

 
EXITEN DIFERENTES GRADOS DE FIMOSIS

  • Grado 1: Se puede retraer perfectamente sin ningún problema, limitado únicamente por adhesiones congénitas al glande.
  • Grado 2: Se puede retraer totalmente. El prepucio queda apretado una vez retraído.
  • Grado 3: Exposición parcial del glande. El prepucio es el factor limitante.
  • Grado 4: Retracción parcial. Sólo el meato es visible.
  • Grado 5: Ligera retracción. Ni el meato ni el glande están visibles.
  • Grado 6: Ningún tipo de retracción es posible.

 
¿COMO SE HACE EL DIAGNÓSTICO?
El diagnóstico es clínico,  se realiza mediante exploración física.
Su médico podrá hacer el diagnostico con una buena exploración donde pueda comprobar la dificultad en la retracción del prepucio, o la presencia de un anillo constrictor asociado a intenso dolor.
Durante la exploración podemos encontrar adherencias entra la superficie interna del prepucio y el glande,  o un frenillo corto que  produce una desviación ventral del glande cuando se retrae el prepucio.
 
¿CUALES SON LAS COMPLICACIONES MAS IMPORTANTES DE  LA FIMOSIS?
Las alteraciones en la piel, secundarias a las infecciones e inflamaciones, aumenta la  susceptibilidad, al CANCER DE PENE. El carcinoma epidermoide es uno de los principales tipos de cáncer de pene invasor asociados al acúmulo de sustancias en los surcos del glande como consecuencia de fimosis en el adulto.
PARAFIMNOSIS: Es una urgencia urológica. Se caracteriza por un prepucio retraído  con un anillo constrictor a la altura del cuello del pene (detrás del glande), impidiendo la recolocación del prepucio sobre el glande. Esto  produce edema (inflamación)   y dificulta la irrigación sanguínea  en la zona estrecha, aumentando el  riesgo de necrosis (muerte del tejido).En caso de presentar una PARAFIMOSIS debe acudir a servicio de urgencias más cercano para una valoración urológica y conseguir reversión de la misma.
 
¿LA FIMOSIS TIENE TRATAMIENTO?
Si. Existen básicamente dos tratamientos.

  • La circuncisiónque ha sido de forma tradicional el tratamiento de elección.Consiste en recortar la piel del pene y la mucosa prepucial redundantes, dejando el glande al descubierto. La circuncisión puede ser total o parcial.
  • Aplicación de masajes con pomadas de corticoides  (0,05 %-0,1 %) dos veces al día durante 20-30 días y así conseguir el desplazamiento del prepucio.

A la hora de decidir el tratamiento hay que tener en cuenta el grado o severidad de la fimosis, especialmente en los niños, donde en muchos casos se intenta un tratamiento más conservador con corticoides locales, consiguiendo remitir la fimosis. En otras ocasiones la circuncisión plástica o radical al final del segundo año de vida es el único tratamiento indicado.
En los adultos que padecen de fimosis la indicación es siempre quirúrgica. Y las indicaciones  son claras, suelen centrarse en aquellos varones que presentan un grado moderado o severo de fimosis, y problemas durante el desarrollo de las relaciones sexuales, o presentan complicaciones secundarias como infecciones e inflamaciones del prepucio o pene de forma repetida.
 
¿QUE COMPLICACIONES PUEDEN PRESENTARSE DESPUES DE LA CIRCUNCISION?
Las complicaciones principales:

  • Molestias por el roce del pene con la ropa interior.
  • Erecciones involuntarias mientras se mantienen los puntos (en los adolescentes y adultos)
  • Dolor local y pequeños sangrados en la zona de los puntos si se produce la erección.

 
¿QUE DEBERIA HACER?
Se recomienda el uso de  prendas interiores ajustadas y la aplicación de hielo (nunca de forma directa) sobre la zona de los puntos en momentos intermitentes no mayor de 10 minutos de duración.
Si existe dolor la toma de analgésicos como el  paracetamol o antinflamatorios.
 
¿SE PUEDE PREVENIR?
En caso de las fimosis  en edad infantil, se pueden evitar si de forma progresiva, durante la higiene diaria se van separando las adherencias con masajes suaves.
Los pediatras podrán enseñar a los padres y al propio niño  a retirar suavemente la piel prepucial.
En caso de los adultos, la educación sanitaria es un pilar fundamental.
 


Dra Ana C. Farías Gorbea.
Médico Especialista MFy C. C. Salud Laguna de Duero. 

REFERENCIAS:

  1. 1 S. Tekgül, H. Riedmiller, E. Gerharz, P. Hoebeke, R. Kocvara, R. Nijman, Chr. Radmayr, R. Stein Guía clínica sobre urología pediátrica p989-P990.
  2.  https://www.revista-portalesmedicos.com/revista-medica/fimosis/
  3.  FELIPE CASTRO S.1 , FELIPE CASTRO A.2 , TRINIDAD RABY B.2 .Fimosis y Circuncisión. Rev Chil Pediatr 2010; 81 (2): 160-165
  4. Tratamiento conservador de la fimosis con esteroides locales, balanitis y enfermedad perianal estreptocócica An Pediatr 2003;58(2):191-202
  5.  Garat JM. Manejo conservador del prepucio. Rev Pediatr Aten Primaria.2001;11:425-33
  6. LÓPEZ MUÑOZ, D. Estudio piloto de prevalencia de la fimosis adquirida en pacientes diabéticos.ENFURO; NÚM. 123. SEPTIEMBRE/OCTUBRE/NOVIEMBRE/DICIEMBRE 2012. P4-7.

 

Revisado: Noviembre 2018.

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