RT Book, Section
A1 O’Rourke, Kevin
A2 Reichman, Eric F.
SR Print(0)
ID 1159807687
T1 Phimosis Reduction
T2 Reichman's Emergency Medicine Procedures, 3e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259861925
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1159807687
RD 2024/04/19
AB A  phimosis  is  a  condition  in  which  the  foreskin  cannot  be  retracted  proximally  to  the  glans  penis.1-18  The  presence  of  a  phimosis  can  interfere  with  cleaning  under  the  foreskin,  allows  the  accumulation  of  secretions  and  debris  (i.e.,  smegma),  and  may  predispose  the  patient  to  infections  and  possible  malignancy.18  It  is  classified  into  two  subgroups  as  physiologic  and  pathologic.  Physiologic  phimoses  occur  naturally  in  newborns.  In  males  younger  than  4  years  of  age,  it  is  normal  for  the  foreskin  not  to  be  retractable  and  it  should  not  be  forcibly  retracted.19  In  older  boys  and  adults,  the  foreskin  can  usually  be  retracted  without  difficulty.1A  pathologic  phimosis  is  the  inability  to  retract  the  foreskin  after  it  was  previously  retractable  or  after  puberty,  usually  secondary  to  scarring  of  the  foreskin  (Figure  180-1).20,21  Surgical  treatment  for  a  phimosis  has  been  known  for  hundreds  of  years.2  A  Byzantine  surgeon  by  the  name  of  Oribasius,  in  the  fourth  century  AD,  gave  a  seemingly  well-acquainted  description  of  a  technique  involving  forced  dilation  of  the  constrictive  foreskin,  scalloping  out  of  its  inner  surface,  then  stretching  it  over  a  parchment-wrapped  lead  tube  placed  between  the  filleted  skin  and  the  glans.2  Current  techniques  for  the  management  of  a  phimosis  in  the  Emergency  Department  are  simple  and  remain  an  important  intervention  directed  at  relieving  urinary  obstruction.