A. Structure and innervation of the human foreskin

B. Normal development of the foreskin

C.1. Phimosis: Conservative non-surgical treatments

C.2. Phimosis: Conservative (i.e., non-excisional) surgical treatments

D. Paraphimosis: Conservative non-surgical treatments

E. Separation of preputial adhesions; preputial stretching and dilation

F. Balanitis: Conservative treatments

G. BXO, balanitis xerotica obliterans (alternatively referred to as lichen sclerosus, lichen sclerosus et atrophicus, and sclerosus lichen atrophicus)

A. Structure and innervation of the human foreskin

• Pardi F. I corpuscoli di Pacini negl’involucri del pene. Monitore Zoologico Italiano 1900;11(8):249-261.
   
• Bazett HC, McGlone B, Williams RG, Lufkin HM. Sensation: I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and Psychiatry 1932;27(3):489-517.
   
• Lambertini G. Documentazioni microfotografiche, dati micrometrici e considerazioni sui corpuscoli del senso genitale dell’uomo. Monitore Zoologico Italiano 1934;45(9)247-255.
   
• Lambertini G. Osservazioni istologiche sui corpuscoli nervosi nei genitali maschili dei bambibi al decimo anno di età. Bollettino della Società Italiana de Biologia Sperimantale 1934;9(11):1294-1297.
   
• Morandi G. Aspetti dei corpuscoli genitali umani e delle clave di Krause accordantisi con la dottrina dei Ruffini sul circuito chiuso. Bollettino della Società Italiana de Biologia Sperimantale 1936;11(5):307-309.
   
• Winkelmann RK. The cutaneous innervation of human newborn prepuce. Journal of Investigative Dermatology 1956;26(1):53-67.
   
• Winkelmann RK. The erogenous zones: their nerve supply and its significance. Proceedings of the Staff Meetings of The Mayo Clinic 1959;34(2):39-47.
   
• Bourlond A, Winkelmann RK. L’innervation du prépuce chez le nouveau-né. Archives Belges de Dermatologie et de Syphiligraphie 1965;21(2):139-153.
   
• de Girolamo A, Cecio A. Contributo alla conoscenza dell’innervazione sensitiva del prepuzio nell’uomo. Bollettino della Società Italiana de Biologia Sperimantale 1968;44(18):1521-1522.
   
• Lakshmanan S, Prakash S. Human prepuce – some aspects of structure and function. Indian Journal of Surgery 1980;42:134-137.
   
• Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. British Journal of Urology 1996;77:291-295.
   

B. Normal development of the foreskin

• Gairdner D. Fate of the foreskin. British Medical Journal 1949;2:1433-1437.
   
• Øster J. Further fate of the forskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Archives of Diseases in Childhood 1968;43(228):200-203.
   
• Osborn LM, Metcalf TJ, Mariani EM. Hygienic care in uncircumcised infants. Pediatrics 1981;67(3):365-367. (Speaks to issue of misconceptions among practitioners.)
   
• Catzel P. The normal foreskin in the young child. SA Mediese Tydskrif 1982;62:751.
   
• Tan HL. Foreskin fallacies and phimosis. Annals Academy of Medicine 1985;14(4):626-630.
   
• Rickwood AMK, Walker J. Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? Annals of the Royal College of Surgeons of England 1989;71(5):275-277.
   
• Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med 1992;85:324-325.
   
• Gordon A, Collin J. Save the normal foreskin: widespread confusion over what the medical indications for circumcision are. (Letter) British Medical Journal 1993;306:1-2.
   
• Williams N, Chell J, Kapila L. Why are children referred for circumcision? British Medical Journal 1993;306:28.
   
• Wright JE. Further to “the further fate of the foreskin”: update on the natural history of the foreskin. The Medical Journal of Australia 1994;160:134-135.
   
• Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractability of the prepuce in 603 Japanese boys. Journal of Urology 1996;156:1813-1815.

C.1. Phimosis: Conservative non-surgical treatments

• Lang K. Eine konservative Therapie der Phimose [Conservative treatment of phimosis]. Monatsschrift für Kinderheilkunde 1986;134(22):824-825.
   
• He Y, Zhou XHS. Balloon dilation treatment of phimosis in boys: report of 512 cases. Chin Med J Engl 1991;104:491-493.
   
• Müller I, Müller H. Eine neue konservative Therapie der Phimose [A new conservative treatment for phimosis]. Monatsschrift für Kinderheilkunde 1993;141(7):607-608. (Translation available: Frederick Hodges, Wellcome Unit for the History of Medicine, University of Oxford, Oxford, U.K.)
   
• Jørgensen ET, Svensson Å. The treatment of phimosis in boys, with a potent topical steroid (clobetasol Propionate 0,05%) Cream. Acta Dermato-Venereologica (Stockholm) 1993; 73(1):55-56.
   
• Kikiros CS, Beasley SW, Woodward AA. The response of phimosis to local steroid application. Pediatric Surgery International (Berlin)1993;8(4):329-332.
   
• Wright JE. The treatment of childhood phimosis with topical steroid. Aust NZ J Surg 1994;64:327-328.
   
• Jørgensen ET, Svensson Å. Phimosis hos pojkar kan behandlas med steroid salva [Phimosis in boys can be treated by a steroid ointment.] (Letter) Lakartidningen 1994;91: 1291.
   
• Golubovic Z, Milanovic D, Vukadinovic V, Rakic I, Perovic S. The conservative treatment of phimosis in boys. British Journal of Urology 1996;78:786-788.
   
• Dewan PA, Tieu HC, Chieng BS. Phimosis: Is circumcision necessary? J Paediatr and Child Health 32 1996:285-289.
   
• Lindhagen T. Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. European Journal of Surgery 1996;162(6):969-972.
   
• Atilla MK, Dündaröz R, Odabas O, Öztürk H, Akin R, Gökçay ES. A nonsurgical approach to the treatment of phimosis: local nonsteroidal anti-inflammatory ointment application. Journal of Urology 1997;158:196-197.
   

C.2. Phimosis: Conservative (i.e., non-excisional) surgical treatments

• Diaz A, Kantor HI. Dorsal slit: a circumcision alternative. Obstet Gynecol 1971;37:619-622.
   
• Parkash S. Phimosis and its plastic correction. J Indian Med Assoc 1972;58:389-390.
   
• Holmland DE. Dorsal incision of the prepuce and skin closure with Dexon in patients with phimosis. Scand J Urol Nephrol 1973;7:97-99.
   
• Emmett AJ. Four V-flap repair of preputial stenosis (phimosis). Plast Reconstr Surg 1975;55:687-689.
   
• Gil Barbosa M, Aguilera Gonzalez C, Alipaz A, Garcia Sanchez JL. La balanolisis como sustituto de la circuncisión. [Balanolysis as a substitute for circumcision] Salud Publica Mex 1976;18:893-899.
   
• Ohjimi T. Ohjimi H. Special surgical techniques for relief of phimosis. J Dermatol Surg Oncol 1981;7:326-330.
   
• Emmett AJ. Z-plasty recontruction for preputial stenosis: a surgical alternative to circumcision. Aust Paediatr J 1982;18:219-220.
   
• Hoffman S, Metz P, Ebbehøj J. A new operation for phimosis: prepuce-saving technique with multiple Y-V-plasties. British Journal of Urology 1984;56:319-321.
   
• Moro G, Gesmundo R, Bevilacqua A, Maiullari E, Gandini R. La circoncisione con postoplatica. Nota di tecnica operatoria. [Circumcision with preputioplasty. Note on operative technique.] Minerva Chir 1988;43:893-894.
   
• Wahlin N. "Triple incision plasty": a convenient procedure for preputial relief. Scand J Urol Nephrol 1992;26:107-110.
   
• de Castella H. Prepuceplasty: an alternative to circumcision. Ann R Coll Surg Engl 1994; 76:257-258.
   
• Cuckow PM, Rix G, Mouriquand PDE. Preputial plasty: a good alternative to circumcision. Journal of Pediatric Surgery 1994;29(4):561-563.
   
• Leal MJ, Mendes J. A circuncisão ritual e correccão plastica da fimose. [Ritual circumcision and the plastic repair of phimosis.] Acta Med Port 1994;7:475-481.
   
• Ohjimi H, Ogata K, Ohjimi T. A new method for the relief of adult phimosis. Journal of Urology 1995;153:1607-1609.
   

D. Paraphimosis: Conservative treatments

• Skoglund Jr., RW, Chapman, WH. Reduction of paraphimosis. Journal of Urology 1970;104(1):137.
   
• Houghton GR. The ‘iced-glove’ method of treatment of paraphimosis. British Journal of Surgery 1973;60(11):876-877.
   
• Hofstetter A. Urologische Notfälle in der Allgemeinpraxis: Folge 9: Blasentamponade, Priapismus, Paraphimose. Fortschritte der Medizin 1982;100(39):1805.
   
• DeVries C. Reduction of paraphimosis with hyaluronidase. Urology 1996;48:464-465.
   

E. Separation of preputial adhesions; preputial stretching and dilation

Note: It is now understood that ‘preputial adhesions’ are normal, and that deliberately separating them is contraindicated (potentially harmful). Thus, articles dealing with this procedure (except Beaugé’s, which is on gentle, self-managed preputial stretching in adolescence) are included here merely as an indication of the evolution of therapy options increasingly from surgical to non-surgical.

• Cooper GG, Thomson GJ, Raine PA. Therapeutic retraction of the foreskin in childhood. Brit Med J Clin Res Ed 1983;286:186-187.
   
• Griffiths DM, Freeman NV. Non-surgical separation of preputial adhesions. The Lancet 1984;8398(2):344.
   
• MacKinlay GA. Save the prepuce: painless separation of preputial adhesions in the outpatient clinic. British Medical Journal 1988;297:590-591.
   
• Beaugé M. Traitement médical du phimosis congénital de l’adolescent [Conservative treatment of primary phimosis in adolescents]. Saint-Antoine University. Paris VI. 1990-1991.
   
• Lim A, Saw Y, Wake PN, Croton RS. Use of a eutectic mixture of local anaesthetics in the release of preputial adhesions: is it a worthwhile alternative? British Journal of Urology 1994;73:428-430.
   

F. Balanitis: Conservative treatments

• Birley HDL, Walker MM, Luzzi GA, Bell R, Taylor-Robinson D, Byrne M, Renton AM. Clinical features and management of recurrent balanitis; association with atopy and genital washing. Genitourinary Medicine 1993; 69:400-403.
   

G. BXO (balanitis xerotica obliterans), alternatively referred to as:
   -lichen sclerosus
   -lichen sclerosus et atrophicus
   -sclerosus lichen atrophicus

• Meyrick Thomas RH, Ridley CM, Black MM. Clinical features and therapy of lichen sclerosus et atrophicus affecting males. Clin Exp Dermatol 1987;12:126-128.
   
• Fortier-Beaulieu M, Thomine E, Mitrofanof P, Laurent P, Heinet J. Lichen scléro-atrophique préputial de l’enfant. Ann Pediatr (Paris) 1990;37:673-676.
   
• Meuli M et al. Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year followup after complete circumcision. Journal of Urology 1994;152(3):987-989.
   

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