Phimosis: Difference between revisions
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==Background== | ==Background== | ||
*Inability to retract the foreskin over the glans penis | *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]] | *Only an ED emergency if it causes [[acute urinary retention]] or is mistaken for [[paraphimosis]] | ||
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==Management== | ==Management== | ||
*'''Physiologic (pediatric):''' Reassurance; do NOT forcefully retract (causes scarring and pathologic phimosis) | *'''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 | *'''Acute urinary retention:''' Gentle dilation of foreskin with hemostat; Foley catheter if needed | ||
*'''Dorsal slit:''' Emergency procedure if urinary retention unresponsive to conservative measures | *'''Dorsal slit:''' Emergency procedure if urinary retention unresponsive to conservative measures | ||
* | *Circumcision: Definitive treatment for refractory pathologic phimosis (outpatient urology referral) | ||
==Disposition== | ==Disposition== | ||
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
- 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