This tab covers the common foreskin disorders — balanitis, phimosis, paraphimosis, and circumcision — and a few other penile conditions.
Balanitis and Phimosis
Balanitis is inflammation of the glans, usually from poor hygiene (failure to retract and clean under the foreskin). Balanoposthitis is a severe form in which a tight phimotic band retains inflammatory secretions, creating a preputial cavity abscess. Phimosis — the inability to retract the foreskin — can result from repeated episodes of balanitis.
Paraphimosis
Painful swelling of the foreskin distal to a phimotic ring when it remains retracted too long. Reduction: apply gentle, steady pressure to decrease the swelling, then push on the glans with the thumbs while pulling the foreskin forward with the fingers. If it has been present for many hours to days, reduction may be impossible and an emergency dorsal slit or circumcision is required.
Circumcision
In adults, circumcision is done under local anaesthesia (a dorsal penile nerve block at the base plus circumferential infiltration); a sleeve technique is favoured in men and older boys. In brief, a preputial cuff is marked and incised through the dartos to Buck's fascia, a second coronal-margin incision is made (with optional frenuloplasty), the intervening sleeve of skin is removed, and the edges are reapproximated after hemostasis. Complications are uncommon — the most common immediate one is hematoma; transient glans hyperesthesia is usual, and minor skin separation may heal by secondary intention.
Other Penile Conditions
- Buried penis — the penile shaft skin is lost to severe inflammation and the penis becomes trapped in the penopubic/scrotal area; patients are often profoundly overweight and frequently diabetic.
- Reactive arthritis — the classic triad of arthritis, conjunctivitis, and urethritis; the urethral involvement is usually mild and self-limited.
- Amyloidosis — a rare urethral disease that should be considered in any urethral mass, presenting with hematuria, dysuria, or urethral obstruction.