Pathologic and physiologic phimosis: approach to the phimotic foreskin.
OBJECTIVE
To review the differences between physiologic and pathologic phimosis, review proper foreskin care, and discuss when it is appropriate to seek consultation regarding a phimotic foreskin.


METHODS
This paper is based on selected findings from a MEDLINE search for literature on phimosis and circumcision referrals and on our experience at the Children's Hospital of Eastern Ontario Urology Clinic. MeSH headings used in our MEDLINE search included "phimosis," "referral and consultation," and "circumcision." Most of the available articles about phimosis and foreskin referrals were retrospective reviews and cohort studies (levels II and III evidence).


RESULTS
Phimosis is defined as the inability to retract the foreskin. Differentiating between physiologic and pathologic phimosis is important, as the former is managed conservatively and the latter requires surgical intervention. Great anxiety exists among patients and parents regarding non-retractile foreskins. Most phimosis referrals seen in pediatric urology clinics are normal physiologically phimotic foreskins. Referrals of patients with physiologic phimosis to urology clinics can create anxiety about the need for surgery among patients and parents, while unnecessarily expanding the waiting list for specialty assessment. Uncircumcised penises require no special care. With normal washing, using soap and water, and gentle retraction during urination and bathing, most foreskins will become retractile over time.


CONCLUSIONS
Physiologic phimosis is often seen by family physicians. These patients and their parents require reassurance of normalcy and reinforcement of proper preputial hygiene. Consultation should be sought when evidence of pathologic phimosis is present, as this requires surgical management.
McGregor
Thomas B
TB
Department of Urology, Queen's University, Kingston, Ont.
Pike
John G
JG
Leonard
Michael P
MP
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001446:Balanitis / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D005194:Family Practice / Q000379:methods; D005500:Follow-Up Studies; D052816:Foreskin / Q000503:physiopathology; D006801:Humans; D006920:Hygiene; D008297:Male; D010688:Phimosis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012075:Remission, Spontaneous; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents