Phimosis
Definition
• condition where the foreskin is too tight to be pulled back over the
head of the penis (glans)
• phimosis causes problems such as difficulty urinating
Epidemiology
• Up to 10% of males will have physiologic phimosis at 3 years of age,
and a larger percentage of children will have only partially retractible
foreskins. One to five percent of males will have nonretractible
foreskins by age 16 years.
Etiology
• Genetic
• Infection
• injury
Pathophysiology
• adhesions between the epithelial layers of the inner prepuce and
glans  doesn’t dissolve
• Forceful retraction of the foreskin leads to microtears at the preputial
orifice that also leads to scarring and phimosis  impairment of
venous and lymphatic flow to the glans leads to venous engorgement
and worsening swelling
Clinical Menifestation
• "ballooning" of the prepuce during urination  pain during urination
• The foreskin is difficult to be pulled back over
• Painful erection
• recurrent urinary tract infections
• a weakened urinary stream
The Diagnosis
• History  based on clinical menifestation, pregnancy
• Physical examination :
- Balloning of the prepuce
- The foreskin cannot be retracted proximally over the glans penis
- adhesions between the epithelial layers of the inner prepuce and
glans
Treatments
• Manual reduction  placing both index fingers on the dorsal border
of the penis behind the retracted prepuce and both thumbs on the
end of the glans
• Minimazing the edema  ice and/or hand compression on the
foreskin, glans, and penis
• Preputioplasty, Circumcision
• Infection  dexamethasone 0,1% ointment  3-4x/day
• Hygiene
Complications
• Recurrence
• Posthitis
• Necrosis and gangrene of the glans
• Autoamputation