II. Definitions
- Phimosis
- Foreskin Stenosis prevents retraction over glans penis
- Contrast with the emergency Paraphimosis in which the foreskin cannot be reduced
III. Causes
IV. Signs
- Unable to retract foreskin over glans penis
V. Complications
- Urine obstruction with urine retention
- Balanitis
- Dyspareunia in males
- Pain on Erection
- Urinary Tract Infection
VI. Management
- Treat Balanitis or Balanoposthitis if present
- Temporizing measures until Urology evaluation
- Foreskin Dilation (Hemostat)
- Foley Catheter
- Dorsal slit cut at 12:00 (similar approach to initial step in Circumcision)
- Performed under Dorsal Penile Nerve Block
- Apply clamp at 12:00 position (dorsal penis) to allow for Hemostasis
- Remove clamp and cut the crushed tissue with sterile scissor
- Topical Corticosteroids (age 5 years and older)
- Emergent Urology referral indications
- Urinary Retention (urinary obstruction) refractory to above (unable to void)
- Associated Cellulitis of foreskin
-
Circumcision indications
- Persistent or recurrent Phimosis
- Recurrent Balanoposthitis or Balanitis
VII. References
- Herman and Arhancet (2020) Crit Dec Emerg Med 34(10): 17-21
- Majoewsky (2012) EM:Rap-C3 2(9): 2
- Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]