Normal physiological non-retractability
- At birth, the normal foreskin (prepuce) is attached to the glans and has a tight opening (preputial ring) at the distal end - it is not retractable in most newborns
- Retractability increases with age, with full retraction possible in:
- 10% of boys at 1 year
- 50% of boys at 10 years
- 99% of boys at 17 years
- A non-retractable foreskin is a normal variant and needs no intervention
Bxo balanitis xerotica obliterans
- Chronic inflammatory process which affects the foreskin but can also extend onto the glans and external urethral meatus
- Keratinisation of the tip of the foreskin causes scaring and the prepuce remains non-retractile
Management
Paraphimosis
- Foreskin cannot be returned to its original position after being retracted
Management
- Conservative treatment involves attempting manual reduction following application of a local anaethetic
- Surgical options involve making a small slit to relieve pressure, or circumcision in severe cases
Hypospadias
- Congenital defect causing the urethral meatus to be located at an abnormal site, usually on the under side of the penis rather than at the tip
Management