SU30.1 | Phimosis, Paraphimosis and Carcinoma Penis — Summary & Reflection

KEY TAKEAWAYS

Three penile conditions share the foreskin as their common thread. Phimosis is a non-retractile prepuce — physiological in young boys (reassure, hygiene, occasionally a topical steroid) and pathological/cicatricial in adults (often BXO/lichen sclerosus), treated by circumcision. Paraphimosis is a urological emergency: a retracted foreskin trapped behind the glans forms a constricting ring that causes progressive oedema and can lead to ischaemia, so it requires prompt manual reduction, a dorsal slit if that fails, and later circumcision. Carcinoma penis is a squamous cell carcinoma of the glans/prepuce whose risk factors are chronic phimosis, retained smegma, poor hygiene and HPV 16/18, with neonatal circumcision protective; it presents as a non-healing ulcer or fungating lesion, demands biopsy (never blind antibiotics), spreads first to the inguinal lymph nodes (always examine both groins), and is managed by organ-sparing surgery or partial/total penectomy with stage-directed inguinal node treatment. The clinical discipline is triage: emergency (paraphimosis), elective benign (phimosis), or cancer pathway (a non-healing penile lesion).

REFLECT

Think back to any patient you have seen with a foreskin or penile complaint, or imagine the next one on your on-call list. If a man presented tonight with a trapped, swollen, painful foreskin, are you confident you could recognise paraphimosis instantly and attempt reduction rather than reaching for an outpatient referral? When you next see a tight foreskin in an adult, will you remember to ask about and look for the scarred white ring of BXO, screen for diabetes, and counsel on hygiene? And if you ever meet an older, uncircumcised man with a sore that 'won't heal', will you examine both groins and arrange a biopsy rather than prescribing another antibiotic? Reflect on how a few minutes of careful history and examination — and the willingness to retract a foreskin and feel a groin — separate reassurance from emergency from cancer.