Phimosis is inability to retract prepuce.
Prepuce of new born is non retractile. At the age of 3 years upto 10% remain non-retractile and at age 16 years, only 1% have a non-retractile foreskin. The foreskin gradually becomes retractile secondary to intermittent erections and keratinization of the inner epithelium.
It is important to understand that most of these phimosis are physiological and do not require any manual retraction of foreskin by the parents. Such manipulations can result in pathological phimosis with scarred skin or balanoposthitis.
Most of the patients with phimosis require only reassurance and education. A short course of topical corticosteroids (0.15 triamcinilone / betamethasone/0.1% mometasone) twice daily for 6-8 wks has success rate of 80-90% in separating preputial adhesions and can be applied if child has symptoms of straining and ballooning of prepuce.
The only indication for surgery (circumcision) is pathologic phimosis with scarred prepuce which is often a result of recurrent balanoposthitis.
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