Emergent Care / Stabilization:
Phimosis is not a urologic emergency, but it may cause pain, urinary retention, urinary tract infections, and balanoposthitis.

Do not forcibly retract the foreskin. This may cause scarring, worsening the patient's phimosis in the future.

Provide pain relief to the patient as needed. Some methods may include oral medication, a penile nerve block with 1% lidocaine, or a ring block at the base of the penis.

If the patient has urinary obstruction secondary to phimosis, the patient may be catheterized with a coudé or small-gauge catheter. Avoid using an external urinary catheter.

Diagnosis Overview:
Phimosis is a condition where the foreskin cannot be retracted from its anatomic position over the glans penis. This may have physiologic or pathologic causes, which may be differentiated clinically, as pathologic phimosis is often associated with scarring of the foreskin. Urology consults may be required in cases of pathologic phimosis, unresolved adolescent physiologic phimosis, and phimosis associated with other urologic conditions.

Symptoms and signs: Physiologic (also known as congenital or primary) phimosis is normal anatomy and almost universally seen with a newborn's uncircumcised penis. This condition is due to natural balanopreputial adhesions. The adhesions are naturally broken down over time due to accumulation of smegma, keratinization of the inner epithelium, and intermittent penile erections. Physiologic phimosis therefore generally resolves with age; the prepuce is estimated to be retractable in 80%-90% of males aged 3 years and 99% of males aged 16 to 18 years. Treatment (see Therapy) may be offered if physiologic phimosis persists past age 10 or is associated with other urologic conditions.

Pathologic (also known as secondary) phimosis is developed due to stenotic scarring of the foreskin and may cause urologic conditions such as balanoposthitis and urinary tract infections (UTIs). Most of the phimosis seen in adults is pathologic.

As a condition affecting the foreskin, both physiologic and pathologic phimosis only occur in uncircumcised patients. Pathologic phimosis is often secondary to inflammatory conditions and injuries such as balanitis xerotica obliterans (BXO) / lichen sclerosus, forceful retraction of the foreskin, and zipper injuries. Furthermore, diabetes (type 1, type 2) is a risk factor for BXO and therefore increases risk of pathologic phimosis. Due to its obstructive characteristics and association with inflammatory conditions, phimosis is a risk factor for balanoposthitis, UTIs, and penile cancer.