In ICD-10, foreskin hypertrophy, phimosis, and paraphimosis (synonyms: Accessory prepuce; Accessory prepuce; Concretio praeputii; Conglutinatio praeputii; Acquired preputial constriction; Frenulum breve praeputii; Congenital paraphimosis; Congenital phimosis; Contracted preputial scar; Paraphimosis; Phimosis; Phimosis due to infection; Preputial leaf adhesion; Preputial adhesion; Preputial narrowing; Preputial narrowing; Preputial adhesion; Preputial adhesion; Preputial hypertrophy; Spanish collar; Preputial narrowing; Preputial hypertrophy) grouped under N47.
Preputial hypertrophy is an enlarged foreskin covering the glans penis.
Phimosis refers to the narrowing of the foreskin. This means that it is not possible to strip back the prepuce (foreskin) over the glans penis. To be distinguished from this is “physiological infant phimosis” with a fusion of the glans with the inner epithelium of the foreskin, which usually comes off at the age of 3 to 5 years.
Paraphimosis (also called Spanish collar) refers to a strangulation or entrapment of the glans penis due to phimosis (constricted foreskin). Paraphimosis is a urologic emergency.
The prevalence (disease incidence) for phimosis is as follows based on age:
- 96% of untreated newborns (physiologic phimosis).
- Approximately 58% after the age of 1 (physiological phimosis).
- 10-35% after the 3rd year of life (physiological phimosis).
- 1% of 16- to 18-year-olds (pathological phimosis; incidence (frequency of new cases) for lichen sclerosus (chronic disease of connective tissue, which is presumed to be one of the autoimmune diseases) in boys before puberty is 0.1-0, 4% based on the total male population)
Course and prognosis: a non-retractable prepuce in childhood and adolescence is normal until the end of puberty (physiological phimosis) and does not require therapy. Pathological phimosis requires treatment and can lead to symptoms such as recurrent balanitis (inflammation of the glans), weakened urinary stream, ballooning during micturition (distension of the foreskin during urination) or a lasting urinary retention. Paraphimosis represents a urological emergency in which the forcibly retracted, constricted foreskin behind the glans penis (glans) in the so-called sulcus coronarius (annular depression behind the glans) results in a laced ring (“Spanish collar”). Professional repositioning of the foreskin (retraction of the foreskin over the glans) should be performed as soon as possible. In some cases, this may require incision of the lacing ring by a minor surgical procedure to prevent the threat of gangrene (death) of the glans and foreskin.
