These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.


Urinary retention secondary to phimosis requires immediate referral to the nearest Emergency Department.


  • A non-retractable foreskin is a normal condition in early childhood with the foreskin naturally separating from the glands and usually becomes retractile by 5 years of age.
  • It is important not to forcibly retract the foreskin as this may result in scar tissue causing phimosis. 
  • Phimosis is a tight foreskin opening and may be associated with ballooning on micturition, a pinhole foreskin opening and a narrow urinary stream.

Pre-referral investigations

  • Physical examination.

Pre-referral management

  • Phimosis - trial of Betamethasone valerate 0.05% daily for 6 weeks.
  • Provide reassurance.

When to refer

Refer to the General Surgery Department if:

  • Poor or no response to Betamethasone valerate 0.05%
  • Balanitis Xerotica Obliterans
  • Inability to retract foreskin after 5 years of age or if other concerns
  • Phimosis with recurrent Urinary Tract Infection.

How to refer

Essential information to include in your referral

  • Patient demographic details including Next of Kin and contact number.
  • Description of condition including ballooning, urinary stream, number of infections, any other relevant history.
  • Treatments trialled including dosages, length of time and any compliance issues.


  1. Lourenção PLTdA, Queiroz DS, de-Oliveira Junior WE, Comes GT, Marques RG, Jozala DR, et al. Observation time and spontaneous resolution of primary phimosis in children. Revista do Colégio Brasileiro de Cirurgiões. 2017;44(5):505-10.
  2. Shahid SK. Phimosis in Children. ISRN Urology. 2012;2012.

Reviewer/Team: Mr Gera, HoD General Surgery, PCH Last reviewed: Sep 2021

Review date: Sep 2022
Endorsed by:

Fast track approval Date:  Sep 2021

This document can be made available in alternative formats on request for a person with a disability.

Referring service