Prepuce‐Preserving Management of Phimosis: Therapeutic Options, Evidence and Clinical Relevance for Urologists

ABSTRACT Phimosis is common, characterised by the inability to retract the prepuce. Whilst circumcision remains the conventional surgical treatment, it is a radical and risk‐associated procedure that may not align with patients' cultural and religious beliefs. There has been a shift towards conservative therapies and surgical techniques that preserve the prepuce. This narrative review aims to provide a comprehensive synthesis of prepuce‐preserving treatment options for phimosis. A structured literature search utilised key search terms relevant to the condition (e.g., ‘phimosis’, ‘non‐retractile foreskin’) and its management (e.g., ‘treatment’, ‘topical corticosteroids’, ‘preputioplasty’). Identified articles underwent manual review before inclusion. An array of alternatives to circumcision is available in the treatment of phimosis. Gentle daily foreskin retraction combined with topical corticosteroid therapy offers an accessible early intervention. Platelet‐rich plasma therapy represents a novel pharmacological technique that demonstrates promise in early research. Dilatation devices such as Novoglan and Phimostop allow for self‐administered, community‐based treatment; both devices have shown encouraging outcomes, including high patient satisfaction and ease of use. In cases refractory or not amenable to conservative therapy, preputioplasty serves as a viable surgical option, encompassing various techniques that, unlike circumcision, aim to preserve the cosmetic and protective functions of the foreskin. A growing array of prepuce‐preserving alternatives to circumcision is available, ranging from conservative therapies to innovative surgical techniques. Raising awareness and improving understanding of these options amongst healthcare providers and patients is crucial to the delivery of patient‐centred care.