Summary
Definition
History and exam
Key diagnostic factors
- newborn and toddler age
- abnormal location of urethra
- incomplete prepuce
- penile curvature and/or torsion
- recent genital exam or procedure
- history of short or small penis
- penile pain and swelling
- foreskin adherent to glans
- penile adhesions and smegma
- penile cicatrix
- penile glans edema
- prominent prepubic fat pad
- presence of hernia or hydrocele
Other diagnostic factors
- forced retraction of foreskin
- dyspareunia
- recent penile trauma
- history of balanitis or balanoposthitis
- urinary obstruction or retention
- necrosis of penile skin
- discoloration of glans
- penile length discrepancy
- history of UTI
- history of pelvic or genitourinary surgery
- erectile dysfunction
Risk factors
- uncircumcised penis (paraphimosis)
- indwelling urinary catheter (paraphimosis)
- parental unawareness (phimosis)
- balanitis xerotica obliterans (phimosis)
- penile trauma (phimosis)
- recurrent balanitis and balanoposthitis (phimosis)
- low birth weight (hypospadias)
- preterm delivery (hypospadias)
- maternal gestational diabetes, obesity, or hypertension (hypospadias)
- family history (hypospadias, congenital penile curvature and/or torsion)
- obesity (buried penis)
- circumcision (trapped penis)
- penile and lower abdominal scarring (buried penis)
- hernia or hydrocele (buried penis)
Diagnostic tests
1st tests to order
- clinical diagnosis
Treatment algorithm
phimosis <12 years old, congenital or physiologic
phimosis ≥12 years old
paraphimosis
hypospadias
congenital penile curvature and/or torsion
concealed penis <3 years old
concealed penis ≥3 years old
micropenis
Contributors
Authors
Nicol Corbin Bush, MD, MSCS
Co-Director, PARC Urology
Vice-President, Operation Happenis
Frisco
TX
Disclosures
NCB declares that she has no competing interests.
Acknowledgements
Dr Nicol Corbin Bush would like to gratefully acknowledge Dr Nicholas Cost, Dr Linda Baker, and Dr Michael Holzer, previous contributors to this topic. NC, LB, and MH declare that they have no competing interests.
Peer reviewers
David Bloom, MD
Chair
Department of Urology
The Jack Lapides Professor of Urology
University of Michigan Medical School
Ann Arbor
MI
Disclosures
DB declares that he has no competing interests.
Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)
Lecturer in Uro-oncology and Consultant Urological Surgeon
Department of Urology
Addenbrooke's Hospital
Cambridge
UK
Disclosures
VG declares that he has no competing interests.
Laurence Baskin, MD
Chief
Pediatric Urology
and Professor
Urology and Pediatrics
UCSF Children's Hospital
San Francisco
CA
Disclosures
LB declares that he has no competing interests.
Differentials
- Balanoposthitis
- Encircling foreign body
- Trapped penis
More DifferentialsGuidelines
- Guidelines on paediatric urology
- Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants
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