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A 5 year old uncircumcised boy is brought in because his parents are concerned that they cannot retract his foreskin. On exam he has phimosis, but there are no signs of inflammation or swelling and no palpable scarring or fibrosis. The patient is asymptomatic and has experienced no ballooning, dysuria, incontinence, dribbling, or recurrent balanoposthitis or UTI.
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February 20, 2018 at 4:35 pm
E. Reassurance is most appropriate. Physiologic phimosis is very common in young children, and gradually resolves spontaneously, usually during the preschool or elementary school years. If the child is completely asymptomatic, no intervention is needed. If the child is getting toward the older range of typical resolution age (older elementary school age) or the parents are impatient, can treat with topical steroids such as betamethasone 0.05% or triamcinolone 0.05% for 4-6 weeks to hasten resolution. Gentle stretching exercises of the prepuce can also be recommended. Forcible retraction should never be performed. Topical estrogen is used in pre-pubertal females with labial adhesion. Referral to urology is only indicated if there is scarring or fibrosis, recurrent balanoposthitis / UTIs, ballooning / urinary retention, or circumcision is desired