Paediatrics: Phimosis and paraphimosis

Phimosis and paraphimosis

The foreskin develops in utero as a protuberance of the penile epidermis, which grows forwards over the glans and adheres to it. The prepuce is normally non-retractable during early childhood. During this period it is very common for parents to notice that the child’s prepuce balloons dur-ing micturition. It is also very common for boys to complain of intermit-tent redness and discomfort from the prepuce. This is rarely the result of bacterial or candidal infection, but simply a chemical irritation from urine under the foreskin. These symptoms are self-limiting and resolve during childhood without intervention (i.e. circumcision).

Circumcision

There are few medical indications for circumcision in boys. The majority of non-religious circumcisions performed in the UK are unnecessary (i.e. nor-mal non-retractile foreskins). Genuine indications for circumcision are:

•   Phimosis: this is almost exclusively caused by balanitis xerotica obliterans (BXO, or lichen sclerosis) which is an uncommon scarring dermatitis characterized by a thickened indurated whitish appearance of the tip of the prepuce. BXO affects 2% of boys by the age of 17yrs and is very rare in those aged <5yrs.

•   Paraphimosis: the prepuce retracts as the boy gets an erection and becomes stuck behind the glans. The glans becomes swollen and oedematous. The paraphimosis should be reduced under general anaesthesia and circumcision scheduled a few weeks later to prevent recurrence.

·  Recurrent balanitis: this is rare.