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Disorders of the glans penis and foreskin

Last updated: May 15, 2020

Summary

The most common disorders of the glans penis and foreskin are balanitis, balanoposthitis, phimosis, and paraphimosis.

Balanitis refers to inflammation of the glans penis. Balanoposthitis refers to inflammation of both the glans penis and the foreskin. Local treatment with topical agents usually suffices to manage both conditions.

Phimosis refers to a tight foreskin that cannot be retracted completely. It is often normal in young children but may be pathological if it develops secondary to scarring. Pathological phimosis most commonly occurs as a complication of balanitis or balanoposthitis. Conservative treatment consists of topical corticosteroids and stretching exercises. Circumcision may be required.

Paraphimosis refers to a condition in which the foreskin has retracted and cannot be returned to its original position. Paraphimosis may occur due to phimosis, sexual activity, or trauma. Pain control and manual reduction may be sufficient, although in some cases surgical intervention is required in order to prevent penile necrosis.

Balanitis and balanoposthitis

References:[1][2]

Phimosis

References:[3][4]

Paraphimosis

  • Definition: retracted foreskin in an uncircumcised male that cannot be returned to its original position
  • Etiology
  • Clinical features
  • Diagnostics: clinical diagnosis
  • Treatment
    • Conservative: manual reduction with adequate pain control (topical anaesthesia, local infiltration, or regional blocks)
    • Surgical
      • Dorsal slit reduction surgery (incision of the constricting band) if manual reduction fails or penile ischemia occurs
      • Circumcision is the last resort
  • Complication: penile necrosis

Paraphimosis is a urological emergency!

References:[5]

References

  1. Barrisford GW. Balanitis and balanoposthitis in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/balanitis-and-balanoposthitis-in-adults.Last updated: January 19, 2017. Accessed: May 5, 2017.
  2. Tews M, Singer JI. Balanoposthitis in children: Clinical manifestations, diagnosis, and treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/balanoposthitis-in-children-clinical-manifestations-diagnosis-and-treatment.Last updated: October 1, 2015. Accessed: May 5, 2017.
  3. Ghory HZ. Phimosis and Paraphimosis. In: Shlamovitz GZ, Phimosis and Paraphimosis. New York, NY: WebMD. http://emedicine.medscape.com/article/777539-overview. Updated: June 2, 2016. Accessed: May 5, 2017.
  4. Wilcox D. Care of the Uncircumcised Penis in Infants and Children. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/care-of-the-uncircumcised-penis-in-infants-and-children.Last updated: August 16, 2017. Accessed: November 26, 2017.
  5. Tews M, Singer JI. Paraphimosis: Clinical manifestations, diagnosis, and treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/paraphimosis-clinical-manifestations-diagnosis-and-treatment.Last updated: January 3, 2017. Accessed: May 5, 2017.