Phimosis refers to the inability to retract the foreskin (prepuce) over the glans penis. It is common in infants and young boys and is often physiological — meaning it’s a normal developmental stage. However, pathological phimosis, which causes symptoms or complications, may require medical attention and, in some cases, surgical intervention.
When left untreated, severe phimosis can lead to recurrent urinary tract infections (UTIs), painful urination (dysuria), bedwetting, foul-smelling urine, and even urinary retention. For parents seeking expert pediatric care, Dr. Sadashiv Bhole, a renowned pediatric urologist in Nagpur, provides accurate diagnosis and effective treatment options for phimosis.
Types of Phimosis
- Physiological Phimosis
- Naturally occurring in newborns and young boys
- Usually resolves spontaneously by age 5–7
- Foreskin may appear tight but is not associated with pain or infection
- Pathological Phimosis
- Results from infection, inflammation, scarring, or forceful retraction
- Foreskin becomes thickened, fibrotic, and non-retractable
- Causes symptoms such as pain, infection, or urinary difficulty
Causes of Pathological Phimosis
- Poor hygiene leading to chronic irritation
- Recurrent balanitis (inflammation of the glans)
- Forceful foreskin retraction
- Congenital narrowing
- Lichen sclerosus (rare chronic inflammatory skin condition)
Symptoms of Phimosis in Children
- Ballooning of foreskin during urination
- Pain or discomfort while urinating (dysuria)
- Redness, swelling, or discharge from the foreskin
- Recurrent UTIs or foul-smelling urine
- Difficulty cleaning the foreskin
- Bedwetting or daytime urinary incontinence due to obstructed flow
- In rare cases, urinary retention or paraphimosis (retracted foreskin stuck behind the glans)
Complications of Untreated Phimosis
- Chronic urinary tract infections
- Balanitis or posthitis (infections of the glans or foreskin)
- Phimosis-related urinary obstruction
- Psychological distress or embarrassment in older children
- Risk of paraphimosis — a urological emergency
- Delayed toilet training or dysfunctional voiding
Diagnosis of Phimosis
Diagnosis is clinical and based on physical examination. No imaging or lab tests are needed unless complications like UTIs, hydronephrosis, or urinary retention are suspected.
If associated with recurrent infections or abnormal voiding, further evaluation may include:
- Urine routine and culture
- Ultrasound KUB (to detect residual urine or bladder changes)
- MCUG (Voiding cystourethrogram) in severe or complicated cases
Treatment of Phimosis in Children
Conservative Management
- Indicated in physiological phimosis or mild cases
- Topical steroid creams (e.g., betamethasone) applied twice daily for 4–6 weeks
- Gentle stretching during bathing — no forceful retraction
- Regular hygiene and observation
Surgical Management
Indicated in cases of:
- Pathological phimosis unresponsive to creams
- Recurrent infections, urinary difficulty, or urinary retention
- Paraphimosis or suspected lichen sclerosus
- Associated urinary complications like bedwetting, incontinence, or dysuria
Surgical Options:
- Circumcision
- Complete removal of the foreskin
- Permanent solution with minimal recurrence
- Commonly performed as a daycare procedure under anesthesia
- Preputioplasty
- Foreskin-preserving procedure
- Preferred for families wishing to retain the foreskin
- Involves widening the tight band without removal
Recovery After Circumcision or Preputioplasty
- Mild pain or swelling for 2–3 days
- Healing usually completed within 7–10 days
- Avoid swimming and strenuous activity for a week
- Proper hygiene to prevent post-operative infection
- Follow-up as advised to monitor healing and comfort
When to Consult a Pediatric Urologist
Parents should consult a pediatric urologist in Nagpur if:
- The child is over 6–7 years and foreskin is still completely non-retractable
- There are repeated infections, painful urination, or urinary retention
- The foreskin appears scarred, white, or thickened
- Bedwetting or incontinence is unexplained
- There’s a concern about hygiene, sexual function, or cosmetic appearance
While phimosis in young boys is often normal, persistent or symptomatic cases require professional evaluation. Whether it’s due to infections, obstruction, or scarring, timely diagnosis and treatment ensure comfort, hygiene, and long-term health. With years of surgical experience and a child-centered approach, Dr. Sadashiv Bhole is among the top choices for pediatric urology care in Nagpur.
