Phimosis and Paraphimosis

Presentation

Phimosis is the inability to retract the foreskin over the glans and is usually the result of a contracted preputial opening ( Fig. 81.1 ). Patients with phimosis may seek acute medical care when they develop signs and symptoms of infection, such as pain and swelling of the foreskin and a purulent discharge. Pediatric patients with acute phimosis are either fussy or complain of penile pain over hours to days. Children also may develop hematuria or urinary retention because of obstruction or dysuria. On physical examination, the physician discovers a tender foreskin that is not easily retracted.

Paraphimosis occurs when a tight foreskin cannot be replaced into its normal position after it is retracted behind the glans. The tight ring of preputial skin (phimotic ring), which is caught behind the glans, creates a venous and lymphatic tourniquet that leads to edematous swelling of the foreskin and glans. It usually presents as a swollen tender penis with a large ventral penile-skin bulge and multiple folds just under the glans ( Figs. 81.2 and 81.3 ).