Meatal Phimosis
Phimosis, or inability to retract the foreskin, is considered physiologic at birth, and is due to natural adhesions that exist between the prepuce and the glans penis. Normal physiologic processes of early childhood contribute to their resolution, allowing the foreskin to be completely retracted by 3 years of age in 90% of uncircumcised males. These processes include accumulation of epithelial debris (smegma) under the prepuce that gradually separates the foreskin from the glans, and intermittent penile erections. Early forceful retraction of the foreskin is not recommended, because recurrent adhesions may occur and a cicatrix may form at the tip of the foreskin causing a secondary phimosis. Less than 1% of males exhibit phimosis by 17 years of age. Routine imaging is not done for evaluation of phimosis. Physical examination, and complications of phimosis such as balanitis or balanoposthitis typically bring this anomaly to the clinician’s attention. Phimosis may also first present when a child has been referred for voiding cystography for other reasons, with difficulties retracting the foreskin noted during catheterization. Treatment usually involves application of a topical corticosteroid cream, which loosens the phimotic ring in the majority of cases. Formal lysis of adhesions is rarely indicated. In uncircumcised boys older than 7 or 8 who demonstrate phimosis resistant to topical corticosteroids and in boys with phimosis that causes ballooning of the foreskin or recurrent balanitis, strong consideration should be given to circumcision or dorsal slit. Review of the literature reveals no significant relationship between other urinary tract or congenital anomaly and phimosis; it typically occurs as an isolated entity. Radiographic appearance of phimosis depends on extent of adhesive disease at the prepuce and glans. Outlet obstructive changes are within the realm of possible though very unlikely, with a normal male urethra most commonly demonstrated. Reference: Campbell’s Urology, 7th ed, pp 2335.
A. Contrast collection within foreskin of uncircumcised male, related to meatal phimosis
B. Mild dilatation of proximal urethra
A
B
Meatal stenosis
Differential Diagnosis
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