Review literature: (Riedmiller et al, 2001).
Phimosis is a congenital or acquired narrowing of the prepuce [fig. phimosis], which hinders (relative phimosis) or prevents (absolute phimosis) the retraction of the prepuce. Natural adhesions (without scarring) during the first years of life between the prepuce and the glans penis have to be distinguished from phimosis.
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Erect penis with phimosis, the retraction of the prepuce is not possible. Public domain figure from http://commons.wikimedia.org |
The prevalence of adhesions between prepuce and glans are age dependent: 58% after 1 year of life, 10–35% after 3 years of life. The prevalence of true phimosis (with scarring) is 8% in 6-year old boys and 1% with 16 years of age.
The prepuce is formed by a fold of skin, which surrounds the glans by the fifth month of fetal development. Initially, the inner sheet of the prepuce is connected to the glans with adhesions. Penile growth, epithelial debris (smegma) and intermittent erections lead to a separation of the prepuce from the glans: 50% after the first year of life, 90% after third year of life.
Recurrent inflammation (balanitis) leads to scarring and narrowing of the prepuce, which itself predisposes to recurrent balanitis.
Frequent complications are urinary tract infections, a paraphimosis or recurrent balanitis. Obstructive voiding dysfunction and urinary retention are possible.
The risk of sexually transmitted diseases is higher in uncircumcised men.
Phimosis is a risk factor for penile cancer. With a good standard of hygiene care, penis cancer is very rare. The risk for cervical cancer is increased in women with uncircumcised men.
Complete (radical) or incomplete (prepuce sparing) circumcision is the cornerstone of phimosis treatment. Please see section circumcision: technique and complications. Contraindications for circumcision are untreated balanitis, coagulation disorders or hypospadias with possible repair in the future.
After local anesthesia of the penis, circumcision is performed using a Gomco clamp, Mogen clamp or with the Plastibell technique. The complication rate for newborn circumcision is 0.2–3%. Most complications are minor, but also devastating complications like partial glans removal or ablative penile injury have occurred. See below for arguments pro or contra prophylactic newborn circumcision.
Prophylactic newborn circumcision is the most common surgical procedure in the United States. Controversies exist about the benefit and harm regarding the prophylactic newborn circumcision, especially if the religious affiliation does not mandate circumcision. Since the diseases, which can be reduced by prophylactic circumcision are very rare, endorsement of routine circumcision is critical.
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Deutsche Version: Phimose
Last update:
Dr. med. Dirk Manski (E-Mail)