Pediatric phimosis: what to do?

By Cristiano Antonino On Feb 19, 2023

Phimosis refers to a narrowing of the preputial ring, which does not allow the foreskin to be retracted downwards and therefore the glans to be uncovered

In infants and children under 3 years of age, phimosis is physiological since the ventral layer of the foreskin is completely adherent to the glans penis (balano-preputial adhesions).

Physiological phimosis tends to resolve itself in 95% within 5 years of age, thanks to the accumulation of epithelial debris (smegma) and the intermittent erections that allow the foreskin to be separated from the glans.

Therefore, in young children it is essential not to try to manually uncover the glans or to perform the so-called “preputial gymnastics”.

These maneuvers, in addition to being painful, can cause preputial lacerations, the scarring of which would in itself cause a real phimosis (scar phimosis).

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Phimosis in children: when to operate?

In case of persistence of balano-preputial adhesions, in children over 5 years of age, the topical application of cortisone creams may be useful, which will make the skin more elastic and therefore favor the sliding of the foreskin.

If the phimosis situation should persist or be associated with complications (recurring balanoposthitis, difficult urination or cicatricial phimosis) the therapy will be exclusively surgical: circumcision or preputial plastic sec. Duhamel.

Circumcision involves removing the preputial ring, making the glans completely or partially uncovered; while in preputial plastic surgery a longitudinal incision is made on the stenotic preputial ring, in order to obtain an enlargement.

In both cases, absorbable suture threads are used and therefore the stitches do not need to be removed at the post-operative check-up, scheduled 5-7 days after surgery.

The surgery is performed on an outpatient or day surgery basis, with discharge a few hours after the surgical procedure.

At home, in the post-operative course, daily medications are provided with local applications of cortisone-based creams to reduce preputial edema.

Children usually return to school 5-7 days after surgery.