Overview
Phimosis
Phimosis describes a non-retractile foreskin. Almost all male children at birth have physiological phimosis until around 2 years of age when spontaneous retraction occurs. This does not usually cause problems unless it causes problems such as urinary obstruction or pain. Pathological phimosis can occur with repeated inflammation and scarring of the foreskin (e.g. secondary to balanoposthitis).
Forcible retraction should be avoided as this can lead to scarring.
Paraphimosis
Paraphimosis is a urological emergency where a tight foreskin is retracted and trapped behind the glans penis and cannot be placed back in its normal position. This constricts the glans penis and reduces venous return, leading to enlargement and oedema of the glans penis. Over time, this can lead to penile ischaemia and infarction.
Risk Factors
- Iatrogenic – indwelling catheters and failing to put the foreskin back in place after
- Chronic balanoposthitis – recurrent inflammation leads to scarring
- Poor hygiene
Management
Overview
Paraphimosis must be reduced as soon as possible. In most cases, gentle compression with saline-soaked gauze reduces oedema. In some cases, placing dextrose–soaked gauze can draw fluid out of the glans penis and reduce oedema and the foreskin can be reduced manually and gradually.
If simple methods fail, refer urgently to a urologist. An incision or emergency circumcision may be necessary.
