Physiological phimosis, do we manage it according to current recommendations in primary care?

Introduction: phimosis is one of the most frequent presenting complaints in pediatric primary care. Most cases are physiologic, and there is increasing consensus in recommending its conservative management, focusing on foreskin care and hygiene. The aim of our study was to analyze the management of this condition in primary care and compare the results to current guidelines. Material and methods: we conducted survey through a questionnaire distributed to pediatricians in our area and performed a literature search for foreskin care protocols or guidelines for the management of phimosis on the main scientific websites. Results: the majority of pediatricians adopt a watchful waiting approach before toilet training (83.6%). One of two years after toilet training, 78.7% of providers start topical treatment, referring the patient to surgery if it fails, even if the child is asymptomatic. Current international guidelines advocate for conservative management of physiological phimosis. In specific cases that require intervention, topical treatment is preferred before considering surgery. Conclusions: in our area, the management of phimosis in primary care adheres to current recommendations in most cases. It is still not clear when asymptomatic phimosis is not going to resolve spontaneously and will require referral to surgery. Education of parents and communication between care teams is essential for adequate management in each case.