Franks BASICS DESCRIPTION True phimosis is the pathologic inability to retract the foreskin over the glans of the penis as a result of scarring. The inability to retract a normal, supple foreskin is not true phimosis. The foreskin is rarely retractable at birth due to normal adhesions between the glans and the inner prepuce. ∼90% are retractable by 3 yr of age, and 99% are retractable by 17 yr, as the epithelial cells that comprise smegma are shed. Parents should be instructed not to forcibly retract the foreskin. ETIOLOGY Possible causes of true phimosis include: Trauma from forcible retraction of the foreskin Repetitive bouts of diaper dermatitis Recurrent balanoposthitis Poor hygiene Poorly performed circumcision Congenital anomalies DIAGNOSIS SIGNS AND SYMPTOMS Dysuria, hematuria Poor urinary stream Whitish, narrowed preputial opening of the foreskin Edema, erythema, and tenderness of prepuce Balanoposthitis (inflammation of the glans and foreskin) Ballooning of foreskin on urination in severe cases Physical-Exam Exam should include an evaluation for potential complications: Obstruction and vascular compromise of glans Occur only in the most extreme cases ESSENTIAL WORKUP In the majority of cases, no workup is necessary.
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