There are adhesions between the prepuce and the glans at birth that should gradually break down with time.
Mean age of 1st foreskin retraction is 10.4 years.
By age of 16 only 1% have phimosis still, which means that 1% at age of 16 will have physiological phimosis
Around 95% of pathological phimosis is due to BXO.
There is keratinisation of the tip of the foreskin that causes scarring and the prepuce will remain non-retractile.
This peak incidence is 9-11 years.
Balloning of the foreskin during micturition but is normal at age 2-4 yo.
Scarring of urethral meatus + irritation, dysuria, haematuria and local infection.
If the meatus is involved it can also cause urinary obstruction.
White, fibrotic and scarred preputial tip.
Can be difficult to visualise the meatus
Send foreskin off to histopathology to confirm diagnosis
Give topical abx when doing circumcision
Bleeding and infection can happen post-treatment
Swelling and serous discharge can also happen post-op.
Untreated BXO can lead to meatal stenosis, phimosis, erosion of glans and prepupce and can extend to the urethra