0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

Balanitis = inflammation of

the glans penis.

Balanoposthitis =

inflammation of the glans

penisandforeskin.

Most common cause =

Candidal infection.

BALANITIS/BALANOPOSTHITIS

Results from inflammation of the glans penis (balanitis) or the glans and fore-
skin (balanoposthitis). The primary cause is infection, most commonly Can-
dida. Contributing factors include diabetes, local trauma or irritation, contact
dermatitis, poor hygiene.

SYMPTOMS/EXAM

■ Pain, discharge, and itching are common symptoms.
■ The glans may appear erythematous and tender to palpation.
■ The foreskin may be adherent or may reveal foul or purulent discharge
when retracted.

DIAGNOSIS

■ The diagnosis is primarily clinical.
■ KOH prep to identify Candidasp.
■ D-stick to evaluate for diabetes

TREATMENT

■ Improve hygiene.
■ Apply topical antifungal ointment.
■ Antibiotics (Keflex) if presence of cellulitis
■ Treatment of diabetes or underlying immunosuppressive condition

A worried mother presents to the ED with her 1-year-old son. The mother

states that although the child was circumcised at birth, she is now unable to

retract his foreskin and notes that when he urinates, the foreskin swells like a

balloon and the child cries uncontrollably. On examination, you see a well-appearing

child with unretractable foreskin. What do you recommend?

The child likely has a secondary phimosis. Daily cleaning of the foreskin and

topical steroids are standard therapy in cases of phimosis. However, with ballooning

of the foreskin upon voiding, revision of the circumcision is recommended.

PHIMOSIS

Phimosis is a constriction of the foreskin resulting in an inability to retract the
prepuce over the glans. This is usually physiologic (resolves by age 4) but may
occur as a result of trauma, infections, poor hygiene, or chemical irritation.

SYMPTOMS/EXAM

■ Pain at the penis, hematuria, abnormal urinary stream, bulging of the fore-
skin with urination
■ Examination classically shows unretractable foreskin with occasional
obstruction of the preputial meatus (see Figure 18.6).

DIAGNOSIS

■ Diagnosis is based on clinical examination.

FIGURE 18.6. Phi-

mosis and paraphimosis.

(Reproduced, with permis-

sion, from Tintinalli JE,

Kelen GD, Stapczynski JS,

Emergency Medicine: A

Comprehensive Study

Guide,6th ed. New York:

McGraw-Hill, 2004:615.)