Phimosis

Disclaimer

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.

Introduction

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

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
Urgent referrals (less than seven days) are made via the PCH Referral Office.

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.

References

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.
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

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