II. Definition

  1. Phimosis
    1. Foreskin Stenosis prevents retraction over glans penis
    2. Contrast with the emergency Paraphimosis in which the foreskin cannot be reduced

III. Causes

  1. Physiologic Phimosis
    1. Newborn: Phimosis is normal in infants
    2. School age: 90% of boys can fully retract foreskin
    3. Puberty: Nearly 100% of boys fully retract foreskin
  2. Pathologic Causes
    1. Trauma
    2. Dermatitis
    3. Balanitis

IV. Signs

  1. Unable to retract foreskin over glans penis

V. Complications

  1. Urine obstruction with urine retention
  2. Balanitis
  3. Dyspareunia in males
  4. Pain on Erection
  5. Urinary Tract Infection

VI. Management

  1. Treat Balanitis or Balanoposthitis if present
  2. Temporizing measures until Urology evaluation
    1. Hemostat dilation
    2. Foley Catheter
    3. Dorsal slit cut at 12:00 (similar approach to initial step in Circumcision)
      1. Performed under Dorsal Penile Nerve Block
      2. Apply clamp at 12:00 position (dorsal penis) to allow for Hemostasis
      3. Remove clamp and cut the crushed tissue with sterile scissor
    4. Topical Corticosteroids (age 5 years and older)
  3. Emergent Urology referral indications
    1. Urinary Retention (urinary obstruction) refractory to above (unable to void)
    2. Associated Cellulitis of foreskin
  4. Circumcision indications
    1. Persistent or recurrent Phimosis
    2. Recurrent Balanoposthitis or Balanitis

VII. References

  1. Herman and Arhancet (2020) Crit Dec Emerg Med 34(10): 17-21
  2. Majoewsky (2012) EM:Rap-C3 2(9): 2
  3. Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]

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Related Studies

Ontology: Phimosis (C0031538)

Definition (NCI) A condition in which there is constriction in the tip of the foreskin resulting in inability to fully retract the foreskin over the glans penis. Causes include balanoposthitis, balanitis xerotica obliterans, and untreated diabetes.
Definition (MSH) A condition in which the FORESKIN cannot be retracted to reveal the GLANS PENIS. It is due to tightness or narrowing of the foreskin opening.
Concepts Finding (T033)
MSH D010688
ICD10 N47.1
SnomedCT 449826002, 52743003, 155921009, 198005005, 198007002, 310861000009108, 266571009, 198006006
English Phimoses, Phimosis, PHIMOSIS, phimosis (diagnosis), phimosis (physical finding), phimosis, Phimosis [Disease/Finding], tight foreskin, phimoses, Phimosis (disorder), Tight frenulum, Tight foreskin, Tight prepuce, Tight foreskin (finding), Phimosis (disorder) [Ambiguous]
French PHIMOSIS, Prépuce serré, Phimosis
Portuguese FIMOSE, Prepúcio apertado, Acrobistite, Fimose
Dutch stugge voorhuid, Phimosis
German verengte Vorhaut, Phimose, Vorhautverengung
Italian Prepuzio stretto, Fimosi
Spanish Prepucio tirante, fimosis (trastorno), fimosis, tirantez del prepucio, fimosis (concepto no activo), prepucio tirante (hallazgo), prepucio tirante, Fimosis
Japanese 緊張性包皮, キンチョウセイホウヒ
Swedish Förhudsförträngning
Czech fimóza, Těsná předkožka
Finnish Esinahan ahtaus
Croatian FIMOZA
Polish Stulejka
Hungarian Szűk ((fityma))
Norwegian Trang forhud, Fimose

Ontology: Foreskin does not retract (C0426347)

Concepts Finding (T033)
SnomedCT 249262009
English Foreskin does not retract, Foreskin does not retract (finding)
Spanish el prepucio no se retrae (hallazgo), el prepucio no se retrae