Foreskin and penile problems in childhood

Foreskin and penile conditions are a common presentation in paediatric surgical and urological practice, representing conditions ranging from normal developmental variations to pathological conditions requiring surgical intervention. A working knowledge of these will aid in planning management. Topics covered include: 1) physiological phimosis – a normal finding in young children that usually resolves spontaneously with age; 2) balanitis xerotica obliterans (BXO) – a progressive scarring condition requiring treatments including circumcision; 3) foreskin adhesions and smegma pearls – benign findings that do not require intervention; 4) paraphimosis – requiring emergent reduction or definitive treatment to prevent ischaemia; 5) hypospadias – representing a spectrum of severity and treatment strategies; 6) congenital megaprepuce and buried penis – which may have different causes and in certain cases surgical correction indicated for significant functional impairment. This article provides a structured approach to recognizing, differentiating, and managing common foreskin and penile conditions in childhood, emphasizing appropriate features for differentiation that will help indicate referral pathways, as well evidence-based treatment strategies for surgical trainees.