Phimosis

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

• Phimosis
• Balanoposthitis
• Paraphimosis
• Priapism
• STDs

Penile trauma types

• Penile amputation
• Penile contusion
• Penile fracture
• Traumatic epididymitis
• Zipper injury to penis

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)

See Also

• Dorsal Slit (Penis)
• Penile diagnoses