Phimosis is inability to retract the foreskin to expose the glans.
Primary phimosis – never able to retract – 1 % incidence at 16 years old.
Secondary (pathological) phimosis – usually due to BXO.
Other causes in adults – recurrent balanitis, diabetes, consider underlying tumour.
Phimosis increases risk of penile cancer.
Complications – pain, recurrent balanitis and balanoposthitis, UTIs.
Treatment:
- Topical steroid 0.05 % betamethasone 1 – 3 months BD (usually best for primary phimosis)
- Circumcision or alternate surgical procedure
Paraphimosis is the inability to reduce a retracted foreskin back over the glans, usually distal to a phimotic ring. Often iatrogenic, or noticed after sexual activity.
Urological emergency – foreskin becomes progressively oedematous, causing constriction of blood supply, leading to necrosis of the foreskin and ulceration. Significant oedema can also constrict the blood supply to the glans.
Management:
- Consider penile block
- Manual compression of oedematous foreskin for 5 minutes
- Adjuncts to reduce oedema – sugar, dextrose soaked gauze, icepacks
- Reduction by pushing glans with thumbs, using fingers to pull back foreskin
- Dundee method – 20 + punctures of oedematous foreskin with needle
- If unable to reduce – dorsal slit encompassing phimotic band
- Consider circumcision if recurrent episodes
Only 30 % having one episode of paraphimosis go on to require circumcision.