Phimosis: Difference between revisions

Latest revision as of 19:45, 1 July 2021

Background

Most uncircumcised infants have normal, physiologic phimosis
- Nearly all cases resolve by 5yr of age
Only emergency if causes acute urinary retention

Clinical Features

An erect penis with phimosis and inability to retract foreskin.

Unable to retract foreskin over glans

Differential Diagnosis

Non-Traumatic penile diagnoses

Penile trauma types

Evaluation

Typically a clinical diagnosis
Ensure that patient able to urinate

Management

Dilation of foreskin with hemostat
Foley cathether if urinary retention is present
Topical steroids - Triamcinolone 0.025% BID x4-6 weeks
- Can avert need for circumcision after phimosis
- Dorsal Slit / circumcision is definitive treatment

Disposition

Discharge with follow-up (primary care/urology)

References

Authors:

@@ Line 1: / Line 1: @@
-==Phimosis==
+==Background==
-===Background===
-*Unable to retract foreskin over glans
 *Most uncircumcised infants have normal, physiologic phimosis
 **Nearly all cases resolve by 5yr of age
 *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.]]
+*Unable to retract foreskin over glans
-===Treatment===
+==Differential Diagnosis==
-*Dilation of foreskin and foley cathether if +urinary retention
+{{Nontrauma penile DDX}}
+{{Penile Trauma DDX}}
-===Disposition===
+==Evaluation==
-Discharge
+*Typically a clinical diagnosis
+*Ensure that patient able to urinate
-==Paraphimosis==
+==Management==
-===Background===
+*Dilation of foreskin with hemostat
-*Foreskin trapped behind glans
+*Foley cathether if urinary retention is present
-*Urologic emergency
+*[[Topical steroids]] - [[Triamcinolone]] 0.025% BID x4-6 weeks
-**May result in necrosis of glans if not reduced
+**Can avert need for circumcision after phimosis
-===Diagnosis===
+**[[Dorsal Slit (Penis)|Dorsal Slit]] / circumcision is definitive treatment
-*Pain, erythema, swelling distal to constricting ring of foreskin
-===Treatment===
+==Disposition==
-*Reduction
+*Discharge with follow-up (primary care/urology)
-**Perform as soon as possible
-**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===
+==See Also==
-*Refer all cases to urology to determine need for circumcision
+*[[Penile dorsal slit]]
+*[[Penile diagnoses]]
+*[[Paraphimosis]]
-==See Also==
+==References==
-[[Dorsal Slit (Penis)]]
+<references/>
-==Source==
-Tintinalli
-[[Category:Peds]]
+[[Category:Urology]]
+[[Category:Pediatrics]]