Phimosis: Difference between revisions

Latest revision as of 09:32, 22 March 2026

Background

Inability to retract the foreskin over the glans penis
Physiologic phimosis: Normal in uncircumcised infants and young boys; nearly all resolve by age 5-7
Pathologic phimosis: Scarring from recurrent balanitis, forceful retraction, or lichen sclerosus (balanitis xerotica obliterans)
Only an ED emergency if it causes acute urinary retention or is mistaken for paraphimosis

Clinical Features

An erect penis with phimosis and inability to retract foreskin.

Inability to retract foreskin over the glans
Ballooning of foreskin during urination (in children — usually benign)
Recurrent balanitis or posthitis
Painful erections (adults)
Weak urinary stream or acute urinary retention (rare but urgent)

Differential Diagnosis

Non-Traumatic penile diagnoses

Phimosis
Balanoposthitis
Paraphimosis
Priapism
STDs
Paraphimosis — foreskin retracted and trapped behind glans (emergency — must reduce immediately)

Evaluation

Clinical diagnosis
Ensure patient can urinate adequately
Assess for signs of infection (erythema, discharge, warmth)

Management

Physiologic (pediatric): Reassurance; do NOT forcefully retract (causes scarring and pathologic phimosis)
Topical steroids: Betamethasone 0.05% or triamcinolone 0.025% BID × 4-6 weeks (success rate 80-90%)
Acute urinary retention: Gentle dilation of foreskin with hemostat; Foley catheter if needed
Dorsal slit: Emergency procedure if urinary retention unresponsive to conservative measures
Circumcision: Definitive treatment for refractory pathologic phimosis (outpatient urology referral)

Disposition

Discharge with urology or primary care follow-up
Urgent urology referral if urinary retention, recurrent infections, or failed topical therapy

References

Authors:

@@ Line 1: / Line 1: @@
-==Phimosis==
+==Background==
-===Background===
+*Inability to retract the foreskin over the glans penis
-*Unable to retract foreskin over glans
+*Physiologic phimosis: Normal in uncircumcised infants and young boys; nearly all resolve by age 5-7
-*Most uncircumcised infants have normal, physiologic phimosis
+*Pathologic phimosis: Scarring from recurrent [[balanitis]], forceful retraction, or [[lichen sclerosus]] (balanitis xerotica obliterans)
-**Nearly all cases resolve by 5yr of age
+*Only an ED emergency if it causes [[acute urinary retention]] or is mistaken for [[paraphimosis]]
-*Only emergency if causes acute urinary retention
-===Work-Up===
+==Clinical Features==
-*Ensure that pt able to urinate
+[[File:Fimosis perfil.jpg|thumb|An erect penis with phimosis and inability to retract foreskin.]]
+*Inability to retract foreskin over the glans
+*Ballooning of foreskin during urination (in children — usually benign)
+*Recurrent [[balanitis]] or posthitis
+*Painful erections (adults)
+*Weak urinary stream or [[acute urinary retention]] (rare but urgent)
-===Treatment===
+==Differential Diagnosis==
-*Dilation of foreskin and foley cathether if +urinary retention
+{{Nontrauma penile DDX}}
+*'''[[Paraphimosis]]''' — foreskin retracted and trapped behind glans (emergency — must reduce immediately)
-===Disposition===
+==Evaluation==
-Discharge
+*Clinical diagnosis
+*Ensure patient can urinate adequately
+*Assess for signs of infection (erythema, discharge, warmth)
-==Paraphimosis==
+==Management==
-===Background===
+*'''Physiologic (pediatric):''' Reassurance; do NOT forcefully retract (causes scarring and pathologic phimosis)
-*Foreskin trapped behind glans
+*Topical steroids: [[Betamethasone]] 0.05% or [[triamcinolone]] 0.025% BID × 4-6 weeks (success rate 80-90%)
-*Urologic emergency
+*'''Acute urinary retention:''' Gentle dilation of foreskin with hemostat; Foley catheter if needed
-**May result in necrosis of glans if not reduced
+*'''Dorsal slit:''' Emergency procedure if urinary retention unresponsive to conservative measures
-===Diagnosis===
+*Circumcision: Definitive treatment for refractory pathologic phimosis (outpatient urology referral)
-*Pain, erythema, swelling distal to constricting ring of foreskin
-===Treatment===
+==Disposition==
-*Reduction
+*Discharge with urology or primary care follow-up
-**Perform as soon as possible
+*Urgent urology referral if urinary retention, recurrent infections, or failed topical therapy
-**Consider penile block or procedural sedation
-**Use bag of ice (3min intervals) or manual compression before attempting reduction
-**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position
-*If fails obtain emergent urology consult and/or perform the following
-**Use 21ga needle to make multiple punctures in foreskin and then perform compression
-**Inject hyaluronidase into the swollen foreskin to decrease edema
-**[[Dorsal Slit (Penis)]]
-===Disposition===
-*Refer all cases to urology to determine need for circumcision
 ==See Also==
-[[Dorsal Slit (Penis)]]
+*[[Paraphimosis]]
+*[[Balanitis]]
+*[[Penile diagnoses]]
+*[[Penile dorsal slit]]
-==Source==
+==References==
-Tintinalli
+<references/>
-[[Category:Peds]]
+[[Category:Urology]]
+[[Category:Pediatrics]]