A 3½-month-old boy was referred to the hospital because of recurrent episodes of urinary tract infection. A voiding cystourethrogram was obtained to identify anatomic abnormalities.
Denouement and Discussion
Pathologic Phimosis
Pathologic phimosis occurs secondary to repeated tears in foreskin, which result in constricting, circumferential cicatrices.1 Clinically, it presents as a nonretractable, thickened distal ring of foreskin. Treatment options include frequent cleansing, application of compresses, steroids, or antibiotic creams, foreskin dilatation using sounds or hemostats, and circumcision.Differential diagnoses based on roentgenographic appearance of the affected area include urethral diverticulum, cystic anomalies of Cowper's glands and ducts, and megalourethra.Phimosis is defined as a condition in which the prepuce is not fully retractable over the glans penis.2 Physiologic and pathologic phimosis are distinct conditions. A study by Gairdner3 and a later study by Oester4 demonstrated that only 4% of newborns have fully retractable foreskin. However, this changes with growth. The foreskin of 20% of boys can be retracted by age 6 months; 50%, by age 1 year, 80%, by age 2 years; 90%, by age 3 years; and 99%, by age 17 years. Nonretractability is usually asymptomatic. Occasionally, as in this patient, there may be ballooning of the foreskin after voiding, causing postvoid dribbling and a characteristic appearance on voiding cystourethrograms.