II. Definitions

  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. Foreskin Dilation (Hemostat)
    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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