Phimosis in adults: narrative review of the current treatments

Abstract

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. 
 Aim: To provide the first review summarizing the available options for the treatment of adult phimosis.
 Methods: A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 - December 2022 was performed using the search terms “phimosis AND treatment”. 
 Results: A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. 
 Conservative treatment is an option and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. 
 Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. 
 Several techniques of preputioplasty and use of in-situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in-situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to the traditional circumcision. 
 Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented.
 Conclusion: 
 Many conservative and surgical treatments are available for the treatment of the adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness.