II. Definitions
- Phimosis
- Foreskin Stenosis prevents retraction over glans penis
- Contrast with the emergency Paraphimosis in which the foreskin cannot be reduced
III. Causes
- Physiologic Phimosis
- Phimosis is normal in infants
- Normal foreskin (preputial skin)
- Resolves spontaneously in most boys by age 3-4 years of age
- Forced retraction in this age group can result in a Paraphimosis (emergency)
- School age (age>3-4 years): 90% of boys can fully retract foreskin
- Puberty: 99% of boys can fully retract foreskin
- Phimosis is normal in infants
- Pathologic Causes of distal prepuce scarring
IV. Signs
- Unable to retract foreskin over glans penis
V. Complications
- Urine obstruction with urine retention
- Balanitis
- Dyspareunia in males
- Pain on Erection
- Urinary Tract Infection
VI. Management
- Treat Balanitis or Balanoposthitis if present
- Emergent Temporizing measures until Urology evaluation (cases of Urinary Retention)
- Foreskin Dilation (Hemostat)
- Foley Catheter
- Dorsal slit cut at 12:00 (similar approach to initial step in Circumcision)
- Performed under Dorsal Penile Nerve Block
- Apply clamp at 12:00 position (dorsal penis) to allow for Hemostasis
- Remove clamp and cut the crushed tissue with sterile scissor
- Emergent Urology referral indications
- Urinary Retention (urinary obstruction) refractory to above (unable to void)
- Associated Cellulitis of foreskin
-
Topical Corticosteroids
- Indications
- Persistent Phimosis in age >=5 years
- Protocol (using a Class IV Topical Corticosteroid)
- Triamcinolone Acetonide (Kenalog) 0.1% cream applied twice daily for 4 to 8 weeks
- Efficacy of 4 to 8 weeks of treatment
- Complete resolution (NNT 5) or partial resolution (NNT 11)
- Longstanding resolution >6 months after treatment (NNT 3)
- References
- Indications
-
Circumcision indications
- Persistent or recurrent Phimosis
- Recurrent Balanoposthitis or Balanitis
VII. References
- Herman and Arhancet (2020) Crit Dec Emerg Med 34(10): 17-21
- Majoewsky (2012) EM:Rap-C3 2(9): 2
- Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]
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Related Studies
| 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 |
| Russian | FIMOZ, ФИМОЗ |
| 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 |
