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Phimosis
Aka: Phimosis, Tight Foreskin, Foreskin Stenosis, Physiologic Phimosis, Foreskin Does Not Retract
- See Also
- Paraphimosis
- Definition
- Phimosis
- Foreskin Stenosis prevents retraction over glans penis
- Contrast with the emergency Paraphimosis in which the foreskin cannot be reduced
- Causes
- Physiologic Phimosis
- Newborn: Phimosis is normal in infants
- School age: 90% of boys can fully retract foreskin
- Puberty: Nearly 100% of boys fully retract foreskin
- Pathologic Causes
- Trauma
- Dermatitis
- Balanitis
- Signs
- Unable to retract foreskin over glans penis
- Complications
- Urine obstruction with urine retention
- Balanitis
- Dyspareunia in males
- Pain on Erection
- Urinary Tract Infection
- Management
- Treat Balanitis or Balanoposthitis if present
- Temporizing measures until Urology evaluation
- Hemostat dilation
- 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
- Topical Corticosteroids (age 5 years and older)
- Emergent Urology referral indications
- Urinary Retention (urinary obstruction) refractory to above (unable to void)
- Associated Cellulitis of foreskin
- Circumcision indications
- Persistent or recurrent Phimosis
- Recurrent Balanoposthitis or Balanitis
- 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]