At birth, the normal foreskin (prepuce) is attached to the glans and has a tight opening (preputial ring) at the distal end - it is not retractable in most newborns
Retractability increases with age, with full retraction possible in:
10% of boys at 1 year
50% of boys at 10 years
99% of boys at 17 years
A non-retractable foreskin is a normal variant and needs no intervention
Bxo balanitis xerotica obliterans
Chronic inflammatory process which affects the foreskin but can also extend onto the glans and external urethral meatus
Keratinisation of the tip of the foreskin causes scaring and the prepuce remains non-retractile
Management
Circumcision
Paraphimosis
Foreskin cannot be returned to its original position after being retracted
Management
Conservative treatment involves attempting manual reduction following application of a local anaethetic
Surgical options involve making a small slit to relieve pressure, or circumcision in severe cases
Hypospadias
Congenital defect causing the urethral meatus to be located at an abnormal site, usually on the under side of the penis rather than at the tip
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