Phimosis in children: an unfinished story

Abstract

Phimosis is a condition in which prepuce cannot be fully retracted behind the glans of the penis, which is common in boys and can occur at any age. Physiologic phimosis is a normal condition that occurs at birth and generally resolves with age as a child grows, which may take until adolescence to be completely retracted. In most cases, external hygiene is adequate care. Whereas pathologic phimosis is a condition in which the foreskin cannot be retracted at an age when retraction normally should be possible or when a previously retractable foreskin becomes non-retractable. This type of phimosis usually occurs in older children and possible ballooning of the foreskin when voiding. It can result from lichen sclerosus, recurrent episodes of balanitis or balanoposthitis, and inappropriate retraction of the foreskin. Topical corticosteroids can loosen the tissues in non-scarred prepuce in approximately 80% of cases. Phimosis can cause complications such as obstructed voiding, urinary tract infection, paraphimosis, and penile cancer. Various classifications; Kikiros, Kayaba, and Sookpotarom, have been developed to assess the severity of phimosis, making it easier to understand and compare the condition across different patients. If a patient experiences complication from phimosis that do not resolve with topical steroids, circumcision should be considered as an option. While pediatric circumcision has been shown to offer benefits in reducing the risk of urinary tract infections, HIV, sexually transmitted diseases, and penile cancer, routine neonatal circumcision is not recommended. Newborn circumcision while controversial is a familial decision and should be based on informed consent.