Phimosis
Phimosis is the inability to retract the foreskin because of a narrow preputial ring. It affects about 1% of boys.
Causes:
- primary (physiological): without sign of scarring (1):
- congenital - rare
- secondary (pathological): due to scarring from conditions such as (1)
- recurrent balanitis
- traumatic retraction of the foreskin
- Balanitis xerotica et obliterans (2)
Presentation is with:
- poor stream
- ballooning of foreskin on micturition
- 'spraying' on micturition
- recurrent attacks of balanitis
- pain on intercourse in adults
- in severe cases, hydronephrosis
Treatment
Physiological phimosis
- since the foreskin becomes retractable with time these patients can be managed conservatively
- topical steroids can be applied to the preputial ring may be useful (2)
Pathological phimosis -
- circumcision
- a short course of topical corticosteroids may be beneficial in mild scarring (2)
References:
- European Society for Paediatric Urology; Guidelines on paediatric urology. 2024 guidelines, available online.
- (2) McGregor TB et al. Pathologic and physiologic phimosis. Can Fam Physician 2007;53(3):445-448
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