From the Guidelines
Non-retractable foreskin, also known as phimosis, should be initially treated with topical steroid creams like betamethasone 0.05% applied twice daily for 4-6 weeks to soften the foreskin and make stretching easier, as recommended by the British Association of Dermatologists' guidelines for the management of lichen sclerosus, 2018 1.
Treatment Options
- For mild cases in children, gentle stretching during bathing may resolve the issue as development continues.
- In adults or more severe cases, manual stretching exercises performed several times daily can gradually increase foreskin elasticity.
- If conservative treatments fail, a urologist may recommend surgical options such as circumcision (complete foreskin removal) or preputioplasty (partial surgical widening).
Importance of Hygiene and Medical Attention
- Phimosis can cause discomfort, difficulty with hygiene, recurrent infections, and painful erections if left untreated.
- It's essential to maintain good hygiene by gently cleaning under the foreskin as much as possible.
- Medical attention should be sought if there is pain, swelling, discharge, difficulty urinating, or if conservative treatments aren't working after several weeks.
Considerations for Treatment Failure
- If treatment with topical corticosteroids appears to fail, it's crucial to consider noncompliance, incorrect diagnosis, or additional superimposed problems such as contact allergy or urinary incontinence, as outlined in the British Association of Dermatologists' guidelines for the management of lichen sclerosus, 2018 1.
- Referral to a specialist clinic may be necessary for further treatment, including systemic retinoids or surgical options.
From the Research
Non-Retractible Foreskin
- A non-retractible foreskin is a condition where the foreskin cannot be retracted over the glans penis, also known as phimosis 2.
- Physiologic phimosis is common in male patients up to 3 years of age, but often extends into older age groups 2.
- Pathological phimosis can be caused by conditions such as balanitis xerotica obliterans, which is an infiltrative skin condition that causes a pathological phimosis and is considered an absolute indication for circumcision 2.
Treatment Options
- Various treatments are available for non-retractible foreskin, including manual retraction therapy, topical steroid therapy, and preputioplasty 2, 3.
- Preputioplasty is a surgical technique that can be used to treat phimosis with a contracted fibrous ring or when medical treatment with steroids has been unsuccessful 3.
- A new preputioplasty technique has been developed, which has shown excellent results in terms of easy and painless foreskin retraction, absence of postoperative phimosis, and cosmetic aspects of the penis 3.
Complications and Risks
- Uncircumcised males are at higher risk of urinary tract infection (UTI) in the first year of life, and circumcision is recommended as an option for males with vesicoureteral reflux (VUR) 4.
- Males with non-retractable foreskin (high grade phimosis) are at higher risk of UTI compared to males with retractable foreskin or those who are circumcised 4.
- Retractable foreskin reduces UTI risk in uncircumcised boys less than one year of age with VUR, and medical phimosis treatment to achieve a retractable prepuce offers an alternative and less invasive modality to reduce UTI risk in males with VUR 4.
Surgical Procedures
- Dorsal relieving incision is a surgical procedure that can be used to treat non-retractile foreskin, and has been shown to be a less invasive, safe, and effective procedure with fewer complications compared to circumcision 5.
- Preputial adhesiolysis is another surgical procedure that can be used to treat non-retractile foreskin, and can be sufficient to retract the foreskin in some patients 5.