Phimosis - Circumcision (Children)

Clinically, the patient may complain of the following symptoms:

• Inability to retract or difficulty in retracting the foreskin
  
• Ballooning of the foreskin when passing urine
  
• Poor stream and dribbling after passing urine
  

Signs:

• "Pin-hole" opening of the foreskin
  
• Inability to see the underlying glans penis

•  "Physiological" phimosis
  

This is due to the adherence of the inner surface of the foreskin with the glans penis.  Naturally these 'adhesions' separate by the age of 5 years.  90% of boys by this age will be able to retract their foreskins.

• "Pathological" phimosis
  

This may be due to forceful retraction of the foreskin which leads to small tears at the opening of the foreskin. Eventually, this may lead to scarring and phimosis.

Poor hygiene may lead to recurrent infections of the foreskin (Balanitis).  This in turn may lead to scarring of the foreskin opening.

​Phimosis is defined as a narrowing or constriction of the foreskin opening which prevents it from being drawn back over the glans.

​Diagnosis is made on clinical examination.

Treatment options:

• Medical
  

This involves applying low-dose steroid creams such as 1% Hydrocortisone or Betamethasone to the foreskin tip twice daily over a period of one month. The success rate is approximately 70%. 

Once the foreskin is found to be retractile, the application of the steroid cream can be stopped.  Parents are then encouraged to continue retracting the foreskin daily at bath times.

• Surgical
  

Surgery to remove the skin covering the tip of the penis is called Circumcision.
This procedure can be done as a Day-case one and is usually done under general anaesthesia.  It takes approximately 20 to 30 minutes to do and there will be 'dissolvable' stitches in the wound.  They would take about 2 to 3 weeks to dissolve.

Following surgery, pain can be controlled by giving paracetamol regularly every four to six hours for the first two to three days.