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Phimosis - pre-referral

This is an elective surgical condition.

See resources for referral form, parent information and more.

Assessment and when to refer

History and physical examination for children 1-7 years

1. Pathological phimosis occurs when there is a narrow waist at the base or tip of the foreskin.
   • May apply Betnovate ½ strength 2x daily directly to the narrowed segment for at least 2 weeks.
     • Consider non-urgent referral for circumcision to the General Surgery Department if not responding after 2 weeks of application of cream.
     • Please provide history and any investigations undertaken.
2. Balanitis xerotica obliterans (BXO) is a condition that affects the foreskin in older boys (> 3 years old). The foreskin has a white scarred  appearance.
   • Absolute indication for circumcision. Refer to the General Surgery Department.
   • Please provide history and any investigations undertaken.

At birth the inner layer of the foreskin is adherent to the glans – a non-retractile foreskin. During childhood there is natural separation as the physiological adhesions are broken down. There is a wide variation in the time period that this takes to occur. It may vary between 1 and 7 yrs. During the separation process, smegma deposits may form beneath the foreskin – these are normal physiological deposits.

For clinical advice call RCH Switchboard tel (03) 9345 5522 and ask for:

• General surgery registrar or fellow on-call
• Department of General Surgery - clinical advice
• Emergency Department - for clinical advice after hours

For outpatient bookings

• Fax to 03 9345 5034 (number also on referral form)
• For urgent appointments please also call 03 9345 5054
• For private referrals see Paediatrician Listing for private surgeon contact details.

Admission enquiries call RCH Switchboard tel (03) 9345 5522 and ask for:

• General admission enquiries (or direct dial 03 9345 6172)
• ED admission enquiries: (or direct dial 03 9345 6477)

• RCH OPD referral form (word)
• Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Kids Connect (Primary Care Liaison) www.rch.org.au/kidsconnect
  OPD resources for GPs page contains all referral forms, clinic information, referral process information, other pre-referral guidelines, MBS Enhanced Primary Care Items and parent information.
• Paediatric Pharmacopoeia
• Penis and foreskin care

References

Urgent paediatric surgical conditions – management guidelines by Tom Clarnette MBBS, MD, FRACS (Paeds). Consultant Paediatric Surgeon, RCH, Melbourne, Australia.

Feedback

Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

Thanks to Consultant Paediatric Surgeon Tom Clarnette for permission to adapt existing guidelines.  Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer.