Phimosis and paraphimosis

Phimosis

• Gentle daily retraction and hygiene; circumcision if conservative treatment fails or with recurrent infection or obstruction.

• C: Betamethasone 0.05% cream to the preputial ring twice daily for 4–6 weeks (with gentle retraction), OR A: hydrocortisone 1% cream twice daily for 4–6 weeks.

• B: Lidocaine 2% gel before procedures; pain: paracetamol 10–15 mg/kg every 6 hours or ibuprofen 5–10 mg/kg every 8 hours.

Paraphimosis (emergency)

• Manual reduction after lubrication and local anaesthesia; dorsal slit or circumcision if it fails.

• B: Lidocaine 2% gel or infiltration; paracetamol or ibuprofen for pain.

• If infection is suspected: B: amoxicillin + clavulanic acid 625 mg every 8 hours for 5–7 days (adults; adjust for children's weight).