Phimosis - Revision history

Danbot: Strip excess bold

2026-03-22T09:32:29Z

Strip excess bold

Danbot: Expand with concise EM-focused content: physiologic vs pathologic, paraphimosis distinction, topical steroid success rate

2026-03-21T01:23:34Z

Expand with concise EM-focused content: physiologic vs pathologic, paraphimosis distinction, topical steroid success rate

← Older revision		Revision as of 01:23, 21 March 2026
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	==Background==		==Background==
	*~~Most~~ uncircumcised infants ~~have normal, physiologic phimosis~~		*Inability to retract the foreskin over the glans penis
	**Nearly all ~~cases~~ resolve by ~~5yr of~~ age		*'''Physiologic phimosis:''' Normal in uncircumcised infants and young boys; nearly all resolve by age 5-7
	*Only emergency if causes acute urinary retention		*'''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==		==Clinical Features==
	[[File:Fimosis perfil.jpg\|thumb\|An erect penis with phimosis and inability to retract foreskin.]]		[[File:Fimosis perfil.jpg\|thumb\|An erect penis with phimosis and inability to retract foreskin.]]
	*~~Unable~~ to retract foreskin over glans		*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==		==Differential Diagnosis==
	{{Nontrauma penile DDX}}		{{Nontrauma penile DDX}}
	~~{{Penile Trauma DDX}}~~		*'''[[Paraphimosis]]''' — foreskin retracted and trapped behind glans (emergency — must reduce immediately)

	==Evaluation==		==Evaluation==
	*~~Typically a clinical~~ diagnosis		*Clinical diagnosis
	*Ensure ~~that~~ patient ~~able to~~ urinate		*Ensure patient can urinate adequately
			*Assess for signs of infection (erythema, discharge, warmth)

	==Management==		==Management==
	*~~Dilation of foreskin with hemostat~~		*'''Physiologic (pediatric):''' Reassurance; do NOT forcefully retract (causes scarring and pathologic phimosis)
	*Foley cathether if urinary retention is present		*'''Topical steroids:''' [[Betamethasone]] 0.05% or [[triamcinolone]] 0.025% BID × 4-6 weeks (success rate 80-90%)
	*[[~~Topical steroids~~]] - [[~~Triamcinolone~~]] 0.025% BID x4-6 weeks		*'''Acute urinary retention:''' Gentle dilation of foreskin with hemostat; Foley catheter if needed
	**~~Can avert need~~ for ~~circumcision after~~ phimosis		*'''Dorsal slit:''' Emergency procedure if urinary retention unresponsive to conservative measures
	**[[Dorsal Slit (~~Penis~~)~~\|Dorsal Slit]] / circumcision is definitive treatment~~		*'''Circumcision:''' Definitive treatment for refractory pathologic phimosis (outpatient urology referral)

	==Disposition==		==Disposition==
	*Discharge with follow-up ~~(primary care/~~urology)		*Discharge with urology or primary care follow-up
			*Urgent urology referral if urinary retention, recurrent infections, or failed topical therapy

	==See Also==		==See Also==
			*[[Paraphimosis]]
			*[[Balanitis]]
			*[[Penile diagnoses]]
	*[[Penile dorsal slit]]		*[[Penile dorsal slit]]
	*[[Penile diagnoses]]
	*[[Paraphimosis]]

	==References==		==References==
	<references/>		<references/>


	[[Category:Urology]]		[[Category:Urology]]
	[[Category:Pediatrics]]		[[Category:Pediatrics]]

Rossdonaldson1: /* See Also */

2021-07-01T19:45:03Z

Rossdonaldson1: /* See Also */

2021-07-01T19:44:29Z

Rossdonaldson1: /* Disposition */

2021-07-01T19:43:37Z

Disposition

← Older revision		Revision as of 19:43, 1 July 2021
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	==Disposition==		==Disposition==
	Discharge with follow-up (primary care/urology)		*Discharge with follow-up (primary care/urology)

	==See Also==		==See Also==

Rossdonaldson1: /* Clinical Features */

2021-07-01T19:43:08Z

Clinical Features

← Older revision		Revision as of 19:43, 1 July 2021
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	==Clinical Features==		==Clinical Features==
			[[File:Fimosis perfil.jpg\|thumb\|An erect penis with phimosis and inability to retract foreskin.]]
	*Unable to retract foreskin over glans		*Unable to retract foreskin over glans

ClaireLewis: /* Management */

2019-09-15T22:38:00Z

Management

← Older revision		Revision as of 22:38, 15 September 2019
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	*Dilation of foreskin with hemostat		*Dilation of foreskin with hemostat
	*Foley cathether if urinary retention is present		*Foley cathether if urinary retention is present
	*Topical steroids - Triamcinolone 0.025% BID x4-6 weeks		*[[Topical steroids]] - [[Triamcinolone]] 0.025% BID x4-6 weeks
	**Can avert need for circumcision after phimosis		**Can avert need for circumcision after phimosis
	**[[Dorsal Slit (Penis)\|Dorsal Slit]] / circumcision is definitive treatment		**[[Dorsal Slit (Penis)\|Dorsal Slit]] / circumcision is definitive treatment

Rossdonaldson1 at 13:44, 1 February 2017

2017-02-01T13:44:21Z

← Older revision		Revision as of 13:44, 1 February 2017
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	==Background==		==Background==
	*Unable to retract foreskin over glans
	*Most uncircumcised infants have normal, physiologic phimosis		*Most uncircumcised infants have normal, physiologic phimosis
	**Nearly all cases resolve by 5yr of age		**Nearly all cases resolve by 5yr of age
	*Only emergency if causes acute urinary retention		*Only emergency if causes acute urinary retention

	==~~Work-Up~~==		==Clinical Features==
	*~~Ensure that patient able~~ to ~~urinate~~		*Unable to retract foreskin over glans

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Nontrauma penile DDX}}		{{Nontrauma penile DDX}}
			{{Penile Trauma DDX}}

			==Evaluation==
			*Typically a clinical diagnosis
			*Ensure that patient able to urinate

	==Management==		==Management==

Rossdonaldson1: Text replacement - "tx" to "treatment"

2016-07-14T23:18:23Z

Text replacement - "tx" to "treatment"

← Older revision		Revision as of 23:18, 14 July 2016
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	*Topical steroids - Triamcinolone 0.025% BID x4-6 weeks		*Topical steroids - Triamcinolone 0.025% BID x4-6 weeks
	**Can avert need for circumcision after phimosis		**Can avert need for circumcision after phimosis
	**[[Dorsal Slit (Penis)\|Dorsal Slit]] / circumcision is definitive tx		**[[Dorsal Slit (Penis)\|Dorsal Slit]] / circumcision is definitive treatment

	==Disposition==		==Disposition==

ClaireLewis: /* Disposition */

2016-07-14T00:47:11Z

Disposition

← Older revision		Revision as of 00:47, 14 July 2016
Line 19:		Line 19:

	==Disposition==		==Disposition==
	Discharge with follow-up (~~PMD~~/urology)		Discharge with follow-up (primary care/urology)

	==See Also==		==See Also==

← Older revision		Revision as of 09:32, 22 March 2026
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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		*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)		*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%)		*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)		*Circumcision: Definitive treatment for refractory pathologic phimosis (outpatient urology referral)

	==Disposition==		==Disposition==

← Older revision		Revision as of 19:45, 1 July 2021
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	==See Also==		==See Also==
	*[[~~Dorsal Slit (Penis)~~]]		*[[Penile dorsal slit]]
	*[[Penile diagnoses]]		*[[Penile diagnoses]]
	*[[Paraphimosis]]		*[[Paraphimosis]]

← Older revision		Revision as of 19:44, 1 July 2021
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	*[[Dorsal Slit (Penis)]]		*[[Dorsal Slit (Penis)]]
	*[[Penile diagnoses]]		*[[Penile diagnoses]]
			*[[Paraphimosis]]

	==References==		==References==