From the Guidelines
Phimosis is diagnosed through a physical examination of the penis, assessing the foreskin's ability to retract over the glans penis, and distinguishing between physiological and pathological phimosis, as recommended by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1.
Diagnosis of Phimosis
The diagnosis of phimosis involves a thorough physical examination, which includes:
- Assessing the foreskin's ability to retract over the glans penis
- Evaluating for signs of balanitis (inflammation of the glans) or balanoposthitis (inflammation of both glans and foreskin)
- Identifying symptoms such as pain, difficulty urinating, ballooning of the foreskin during urination, or recurrent infections
- Distinguishing between physiological phimosis (normal in young children) and pathological phimosis (caused by scarring or inflammation)
Importance of Early Diagnosis
Early diagnosis of phimosis is crucial to prevent complications, including:
- Urinary retention
- Recurrent infections
- Sexual dysfunction in adults As stated in the guidelines, a biopsy must always be considered in patients with suspected neoplastic change, disease that fails to respond to adequate treatment, or when circumcision is performed 1.
Additional Tests
In severe cases, additional tests may be needed to assess for urinary tract complications, such as:
- Urine flow rate and postvoid residual volume measurement to identify urethral involvement by lichen sclerosus
- Referral to a urologist for further investigation and management of lower urinary tract symptoms 1
Treatment and Follow-up
Treatment for phimosis may involve topical steroids, and in some cases, circumcision may be necessary, as recommended by the guidelines 1. Follow-up is essential to assess disease response, monitor for complications, and provide ongoing management, including referral to a specialist urologist if necessary 1.
From the Research
Diagnosis of Phimosis
Phimosis is a condition where the prepuce cannot be retracted over the glans penis 2. The diagnosis of phimosis can be made based on the inability to completely retract the foreskin and expose the glans 3.
Key Characteristics
Some key characteristics of phimosis include:
- Inability to retract the foreskin over the glans penis
- Pain or discomfort during retraction
- Inflammation or infection of the foreskin or glans
- Presence of balanitis xerotica obliterans, a skin condition that can cause pathological phimosis 2
Diagnostic Considerations
When diagnosing phimosis, it is essential to consider the following:
- Age of the patient: Physiologic phimosis is common in male patients up to 3 years of age, but often extends into older age groups 2
- Severity of the condition: Phimosis can range from mild to severe, and the diagnosis should take into account the degree of foreskin retraction and any associated symptoms 3
- Presence of underlying conditions: Certain conditions, such as lichen sclerosis, diabetes, and obesity, can increase the risk of developing phimosis 4
Diagnostic Evaluation
A diagnostic evaluation for phimosis may involve:
- Physical examination: To assess the degree of foreskin retraction and any associated symptoms
- Medical history: To identify any underlying conditions that may be contributing to the development of phimosis
- Laboratory tests: To rule out any underlying infections or conditions that may be causing the phimosis 3