Patient will present with → foreskin in normal position that cannot be retracted (phimosis).
Patient will present with → entrapment of the foreskin in the retracted position (paraphimosis).
Phimosis – foreskin in normal position and cannot be retracted
Paraphimosis – is entrapment of the foreskin in the retracted position; it is a medical emergency.
Paraphimosis can occur when the foreskin is left retracted (behind the glans penis). Retraction may occur during catheterization or physical examination. If the retracted foreskin is somewhat tight, it functions as a tourniquet, causing the glans to swell, both blocking the foreskin from returning to its normal position and worsening the constriction.
Always remember to reduce the foreskin after urethral catheterization.
Diagnosis is clinical
Paraphimosis → should be regarded as an emergency, because constriction leads quickly to vascular compromise and necrosis of the glans penis.
Firm circumferential compression of the glans with the hand may relieve edema sufficiently to allow the foreskin to be restored to its normal position. If this technique is ineffective, a dorsal slit done using a local anesthetic relieves the condition temporarily. Circumcision is then done when edema has resolved.
Phimosis → is normal in children and typically resolves by age 5.
Treatment is not required in the absence of complications such as balanitis, UTIs, urinary outlet obstruction, unresponsive dermatologic disease, or suspicion of carcinoma.
Betamethasone cream 0.05% bid to tid applied to the tip of the foreskin and the area touching the glans for 3 mo is often effective. Stretching the foreskin gently with 2 fingers or over an erect penis for 2 to 3 wk with care not to cause paraphimosis is also successful. If conservative measures are ineffective, circumcision is the preferred surgical option.
In adults, phimosis may result from balanoposthitis or prolonged irritation. Risk of UTI, penile cancer, HIV, and sexually transmitted diseases is increased. The usual treatment is circumcision.
Balanitis is commonly seen with phimosis but specifically refers to the inflammation of the glans penis.
Hypospadias is a congenital condition associated with a ventral location of the urethral meatus proximal to the glans.
Phimosis is the inability to retract the foreskin from its original position.
Urethral meatal stricture
Urethral meatal stricture occurs following inflammation of the urethra from chronic infection or trauma.
Circumcision may be performed but only after infection is cleared
See A for explanation
Immediate retraction of the foreskin
Because the foreskin cannot be retracted, it cannot be reduced.
Oral antifungal agents
See A for explanation
Balanoposthitis can lead to phimosis when chronic but because it can be treated easily with medications and proper hygiene, is not itself an indication for circumcision.
Although penile carcinoma occurs in those who have not been circumcised, it is due to poor hygiene and chronic infection.
Hypospadias itself does not require removal of the foreskin for treatment.
Peyronie disease affects the shaft of the penis and does not involve the foreskin in any way that would indicate a need for removal.