Highlights & Basics
- Anatomic penile abnormalities are congenital and acquired conditions that affect the male external genitalia; some may require emergency evaluation and treatment.
- Diagnosis is based on clinical findings identified in a wide variety of age groups from newborn to adult.
- Localized occurrences of inflammation and infection are amenable to medical treatment; surgery with varying degrees of reconstruction may be required.
- Inadequate, untimely, and unsuccessful treatment may have long-term consequences of sexual dysfunction or cosmetic deformity of the penis.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Paraphimosis
Pathologic phimosis with cicatrix
Infant with distal hypospadias. The urethral meatus is located in the glans or distal shaft and prepuce is typically incomplete
Infant with proximal hypospadias. The urethral meatus is located from the perineum to the proximal shaft
Congenital penile curvature (congenital chordee)
Congenital buried penis
Congenital buried penis: abundant inner preputial skin with paucity of shaft skin
Congenital buried penis
Congenital buried penis
Physiologic phimosis
Balanitis xerotica obliterans (lichen sclerosis)
Repaired congenital buried penis (with bilateral hernia repair and scrotoplasty)
Repaired congenital buried penis
Early paraphimosis
Pathologic phimosis in a patient with balanitis xerotic obliterans
Small keratin pearls
Large keratin pearl
Citations
European Association of Urology; European Society for Paediatric Urology. EAU guidelines on paediatric urology. Apr 2024 [internet publication].[Full Text]
Dave S, Afshar K, Braga LH, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J. 2018 Feb; 12(2):E76-99.[Abstract][Full Text]
British Association of Paediatric Surgeons. Management of foreskin conditions. Jun 2006 [internet publication].[Full Text]
1. Radhakrishnan J, Razzaq A, Manickam K, et al. Concealed penis. Pediatr Surg Int. 2002 Dec;18(8):668-72.[Abstract]
2. Merriman LS, Arlen AM, Broecker BH, et al. The GMS hypospadias score: assessment of inter-observer reliability and correlation with post-operative complications. J Pediatr Urol. 2013 Dec;9(6 pt a):707-12.[Abstract]
3. Arlen AM, Kirsch AJ, Leong T, et al. Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: correlation with postoperative complications. J Pediatr Urol. 2015 Apr;11(2):71.e1-5.[Abstract]
4. Tang SH, Kamat D, Santucci RA. Modern management of adult-acquired buried penis. Urology. 2008 Jul;72(1):124-7.[Abstract]
5. Gairdner D. The fate of the foreskin. A study of circumcision. Br Med J. 1949 Dec 24;2(4642):1433-7.[Abstract][Full Text]
6. Morris BJ, Matthews JG, Krieger JN. Prevalence of phimosis in males of all ages: systematic review. Urology. 2020 Jan;135:124-32.[Abstract]
7. Øster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968 Apr;43(228):200-3.[Abstract][Full Text]
8. Spilsbury K, Semmens JB, Wisniewski ZS, et al. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust. 2003 Feb 17;178(4):155-8.[Abstract]
9. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int. 1999 Jul;84(1):101-2.[Abstract]
10. Bromage SJ, Crump A, Pearce I. Phimosis as a presenting feature of diabetes. BJU Int. 2008 Feb;101(3):338-40.[Abstract]
11. European Association of Urology; European Society for Paediatric Urology. EAU guidelines on paediatric urology. Apr 2024 [internet publication].[Full Text]
12. Bhat A, Bhat M, Kumar V, et al. The incidence of isolated penile torsion in North India: a study of 5,018 male neonates. J Pediatr Urol. 2017 Oct;13(5):491.e1-491.e6.[Abstract]
13. Eroglu E, Gundogdu G. Isolated penile torsion in newborns. Can Urol Assoc J. 2015 Nov 4;9(11-12):E805-7.[Abstract][Full Text]
14. Yu X, Nassar N, Mastroiacovo P, et al. Hypospadias prevalence and trends in international birth defect surveillance systems, 1980-2010. Eur Urol. 2019 Oct;76(4):482-90.[Abstract][Full Text]
15. Springer A, van den Heijkant M, Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol. 2016 Jun;12(3):152.e1-7.[Abstract]
16. Shan X, Aguilar S, Canon S. Hypospadias prevalence by severity and associated risk factors: a population-based active surveillance analysis. J Pediatr Urol. 2023 Dec;19(6):720.e1-720.e9.[Abstract]
17. Chen MJ, Karaviti LP, Roth DR, et al. Birth prevalence of hypospadias and hypospadias risk factors in newborn males in the United States from 1997 to 2012. J Pediatr Urol. 2018 Oct;14(5):425.e1-425.e7.[Abstract]
18. Monier I, Hachem S, Goffinet F, et al. Population-based surveillance of congenital anomalies over 40 years (1981-2020): results from the Paris registry of congenital malformations (remaPAR). J Gynecol Obstet Hum Reprod. 2024 Jun;53(6):102780.[Abstract]
19. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999 Jan;83(Suppl 1):34-44.[Abstract]
20. Mattioli G, Repetto P, Carlini C, et al. Lichen sclerosus et atrophicus in children with phimosis and hypospadias. Pediatr Surg Int. 2002 May;18(4):273-5.[Abstract]
21. Becker K. Lichen sclerosus in boys. Dtsch Arztebl Int. 2011 Jan;108(4):53-8.[Abstract][Full Text]
22. Brouwer OR, Albersen M, Parnham A, et al. European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update. Eur Urol. 2023 Jun;83(6):548-60.[Abstract][Full Text]
23. Bacsu C, Van Zyl S, Rourke KF. A prospective analysis of consultation for difficult urinary catheter insertion at tertiary care centres in Northern Alberta. Can Urol Assoc J. 2013 Sep-Oct;7(9-10):343-7.[Abstract][Full Text]
24. Manjunath AS, Hofer MD. Urologic emergencies. Med Clin North Am. 2018 Mar;102(2):373-85.[Abstract]
25. Jones SA, Flynn RJ. An unusual (and somewhat piercing) cause of paraphimosis. Br J Urol. 1996 Nov;78(5):803-4.[Abstract]
26. Higgins SP. Painful swelling of the prepuce occurring during penile erection. Genitourin Med. 1996 Dec;72(6):426.[Abstract][Full Text]
27. van Rooij IA, van der Zanden LF, Brouwers MM, et al. Risk factors for different phenotypes of hypospadias: results from a Dutch case-control study. BJU Int. 2013 Jul;112(1):121-8.[Abstract]
28. Fernandez N, Chua M, Villanueva J, et al. Neural network non-linear modeling to predict hypospadias genotype-phenotype correlation. J Pediatr Urol. 2023 Jun;19(3):288.e1-288.e11.[Abstract]
29. Zhang K, Li Y, Mao Y, et al. Steroid 5-alpha-reductase type 2 (SRD5A2) gene V89L polymorphism and hypospadias risk: a meta-analysis. J Pediatr Urol. 2017 Dec;13(6):630.e1-630.e9.[Abstract]
30. Ollivier M, Paris F, Philibert P, et al. Family history is underestimated in children with isolated hypospadias: a French multicenter report of 88 families. J Urol. 2018 Oct;200(4):890-4.[Abstract]
31. Redman JF. Buried penis: a congenital syndrome of a short penile shaft and a paucity of penile skin. J. Urol. 2005 May;173(5):1714-7.[Abstract]
32. Kiss A, Kiraly L, Kutasy B, et al. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol. 2005 Jul-Aug;22(4):305-8.[Abstract]
33. Choe JM. Paraphimosis: current treatment options. Am Fam Physician. 2000 Dec 15;62(12):2623-6, 2628.[Abstract][Full Text]
34. Metcalfe PD, Rink RC. The concealed penis: management and outcomes. Curr Opin Urol. 2005 Jul;15(4):268-72.[Abstract]
35. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician. 2007 Mar;53(3):445-8.[Abstract][Full Text]
36. Donatucci C, Ritter E. Management of buried penis in adults. J Urol. 1998 Feb;159(2):420-4.[Abstract]
37. Fredell L, Kockum I, Hansson E, et al. Heredity of hypospadias and the significance of low birth weight. J Urol. 2002 Mar;167(3):1423-7.[Abstract]
38. Jensen MS, Wilcox AJ, Olsen J, et al. Cryptorchidism and hypospadias in a cohort of 934,538 Danish boys: the role of birth weight, gestational age, body dimensions, and fetal growth. Am J Epidemiol. 2012 May 1;175(9):917-25.[Abstract][Full Text]
39. Wang Y, Wang L, Yang Z, et al. Association between perinatal factors and hypospadias in newborns: a retrospective case-control study of 42,244 male infants. BMC Pregnancy Childbirth. 2022 Jul 20;22(1):579.[Abstract][Full Text]
40. Wu Y, Liu B, Sun Y, et al. Association of maternal prepregnancy diabetes and gestational diabetes mellitus with congenital anomalies of the newborn. Diabetes Care. 2020 Dec;43(12):2983-90.[Abstract][Full Text]
41. Maizels M, Zaontz M, Donovan J, et al. Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder. J Urol. 1986 Jul;136(1 Pt 2):268-71.[Abstract]
42. Dave S, Afshar K, Braga LH, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J. 2018 Feb; 12(2):E76-99.[Abstract][Full Text]
43. Fernandez N, Maxwell A, Noonavath M, et al. Comprehensive multidisciplinary phenotyping of patients with hypospadias. A pilot study. J Pediatr Urol. 2023 Aug;19(4):397.e1-397.e7.[Abstract]
44. Caldwell J, Noonavath M, Maxwell A, et al. Comparison of hypospadias phenotype pixel segmentation to GMS score. J Pediatr Urol. 2024 Aug;20(4):682-7.[Abstract]
45. Hatipoğlu N, Kurtoğlu S. Micropenis: etiology, diagnosis and treatment approaches. J Clin Res Pediatr Endocrinol. 2013;5(4):217-23.[Abstract][Full Text]
46. The Royal Children's Hospital Melbourne. Clinical practice guidelines: the penis and foreskin. Jul 2018 [internet publication].[Full Text]
47. Webster TM, Leonard MP. Topical steroid therapy for phimosis. Can J Urol. 2002 Apr;9(2):1492-5.[Abstract]
48. Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol. 1999 Sep;162(3 Pt 2):1162-4.[Abstract]
49. Ghysel C, Vander Eeckt K, Bogaert GA. Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys. Urol Int. 2009;82(1):81-8.[Abstract]
50. Moreno G, Ramirez C, Corbalán J, et al. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev. 2024 Jan 25;1(1):CD008973.[Abstract]
51. Cuckow PM, Rix G, Mouriquand PD. Preputial plasty: a good alternative to circumcision. J Pediatr. Surg. 1994 Apr;29(4):561-3.[Abstract]
52. British Association of Paediatric Surgeons. Management of foreskin conditions. Jun 2006 [internet publication].[Full Text]
53. Little B, White M. Treatment options for paraphimosis. Int J Clin Pract. 2005 May;59(5):591-3.[Abstract]
54. American Urological Association. Urologic emergencies. Nov 2022 [internet publication].[Full Text]
55. Mackway-Jones K, Teece S. Best evidence topic reports. Ice, pins, or sugar to reduce paraphimosis. Emerg Med J. 2004 Jan;21(1):77-8.[Abstract][Full Text]
56. Cahill D, Rane A. Reduction of paraphimosis with granulated sugar. BJU Int. 1999 Feb;83(3):362.[Abstract]
57. Kerwat R, Shandall A, Stephenson B. Reduction of paraphimosis with granulated sugar. Br J Urol. 1998 Nov;82(5):755.[Abstract]
58. Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int. 1999 May;83(7):859-60.[Abstract]
59. Litzky GM. Reduction of paraphimosis with hyaluronidase. Urology. 1997 Feb;50(3):160.[Abstract]
60. Pohlman GD, Phillips JM, Wilcox DT. Simple method of paraphimosis reduction revisited: point of technique and review of the literature. J Pediatr Urol. 2013 Feb;9(1):104-7.[Abstract][Full Text]
61. Bush NC, Holzer M, Zhang S, et al. Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys. J Pediatr Urol. 2013 Jun;9(3):252-6.[Abstract]
62. Snodgrass W, Dajusta D, Villanueva C, et al. Foreskin reconstruction does not increase urethroplasty or skin complications after distal TIP hypospadias repair. J Pediatr Urol. 2013 Aug;9(4):401-6.[Abstract]
63. Snodgrass WT, Khavari R. Prior circumcision does not complicate repair of hypospadias with an intact prepuce. J Urol. 2006 Jul;176(1):296-8.[Abstract]
64. Godlewski KF, Mittal S, Hyacinthe N, et al. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty? J Urol. 2023 Aug;210(2):352-9.[Abstract]
65. Thanneeru SK, Gupta A, Chanchlani R, et al. Preoperative topical estrogen application in the management of hypospadias: a systematic review. Pediatr Surg Int. 2024 May 13;40(1):132.[Abstract]
66. Wright I, Cole E, Farrokhyar F, et al. Effect of preoperative hormonal stimulation on postoperative complication rates after proximal hypospadias repair: a systematic review. J Urol. 2013 Aug;190(2):652-9.[Abstract]
67. Netto JM, Ferrarez CE, Schindler Leal AA, et al. Hormone therapy in hypospadias surgery: a systematic review. J Pediatr Urol. 2013 Dec;9(6 Pt B):971-9.[Abstract]
68. European Association of Urology. EAU guidelines on sexual and reproductive health. Apr 2024 [internet publication].[Full Text]
69. Borsellino A, Spagnoli A, Vallasciani S, et al. Surgical approach to concealed penis: technical refinements and outcome. Urology. 2007 Jun;69(6):1195-8.[Abstract]
70. Academy of Medical Royal Colleges. Penile circumcision. Sep 2024 [internet publication].[Full Text]
71. Madsen BS, van den Brule AJ, Jensen HL, et al. Risk factors for squamous cell carcinoma of the penis - population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. 2008 Oct;17(10):2683-91.[Abstract]
72. Snodgrass WT, Bush NC. Hypospadias. In: Snodgrass WT, ed. Pediatric urology: evidence for optimal patient management. New York, NY: Springer; 2013:117-52.
73. Kaplan GW. Complications of circumcision. Urol Clin North Am. 1983 Aug;10(3):543-9.[Abstract]
74. Pohl HG, Rana S, Sprague BM, et al. Discrepant rates of hypospadias surgical complications:a comparison of U.S. news and world report and pediatric health information system® data and published literature. J Urol. 2020 Mar;203(3):616-23.[Abstract]
