• Clinical science

Disorders of the glans penis and foreskin

Abstract

The most common disorders of the glans penis and foreskin are balanitis, balanoposthitis, phimosis, and paraphimosis.

Balanitis refers to inflammation of the glans penis. Balanoposthitis refers to inflammation of both the glans penis and the foreskin. Local treatment with topical agents usually suffices to manage both conditions.

Phimosis refers to a tight foreskin that cannot be retracted completely. It is often normal in young children but may be pathological if it develops secondary to scarring. Pathological phimosis most commonly occurs as a complication of balanitis or balanoposthitis. Conservative treatment consists of topical corticosteroids and stretching exercises. Circumcision may be required.

Paraphimosis refers to a condition in which the foreskin has retracted and cannot be returned to its original position. Paraphimosis may occur due to phimosis, sexual activity, or trauma. Pain control and manual reduction may be sufficient, although in some cases surgical intervention is required in order to prevent penile necrosis.

Balanitis and balanoposthitis

References:[1][2]

Phimosis

  • Definition: tight foreskin that cannot be completely retracted over the glans penis
  • Epidemiology: Physiologic phimosis occurs in up to 10% of males at 3 years of age, but is less prevalent by 16 years of age (occurring in 1–5% of males).
  • Etiology
    • Post-infectious complication following balanoposthitis
    • Congenital
    • Scarring after trauma or circumcision
  • Clinical features
  • Diagnostics: clinical diagnosis
  • Treatment
    • Conservative: topical corticosteroid cream: (contraindicated in recurrent infection) and stretching exercises
    • Surgical: : vertical incision (incision of the constricting bands) or circumcision if conservative management fails
  • Complications

References:[3]

Paraphimosis

  • Definition: retracted foreskin in an uncircumcised male that cannot be returned to its original position
  • Etiology
    • Complication of phimosis (physiological or pathological)
    • Iatrogenic (i.e., following genitourinary procedures such as bladder catheterization)
    • Trauma (vigorous sexual intercourse, forceful retraction of foreskin while urinating, piercing)
  • Clinical features
    • Noticeable band of constricting tissue (at the coronal sulcus)
    • Foreskin cannot be returned to its original position
    • Edema and pain of the glans penis
    • Features of penile ischemia (blue penile skin and firm glans penis)
  • Diagnostics: clinical diagnosis
  • Treatment
    • Conservative: manual reduction with adequate pain control (topical anaesthesia, local infiltration, or regional blocks)
    • Surgical
      • Dorsal slit reduction surgery (incision of the constricting band) if manual reduction fails or penile ischemia occurs
      • Circumcision is the last resort
  • Complication: penile necrosis

Paraphimosis is a urological emergency!

References:[4]