Balanitis

(info below is general, not specific to pediatrics)

• inflammation of the glans penis
• balanoposthitis = Balanitis involving the foreskin or prepuce i
• the most common complication of balanitis is phimosis, or inability to retract the foreskin from the glans penis.
• Pathophysiology: Uncircumcised men with poor personal hygiene are most affected by balanitis. Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema. Adherence of the foreskin to the inflamed and edematous glans penis causes phimosis, which is the major presenting complication of balanitis seen in the ED.

Emergency Department Care:

• Patients presenting with balanitis but without phimosis should receive the following recommendations and treatment:
• Retract the foreskin daily and soak in warm water to clean penis and foreskin.
• Apply bacitracin (not Neosporin) for pediatric patients.
• Apply topical clotrimazole for adult men with probable candidal balanitis.
• Obtain a culture of discharge in unusual cases, then treat the infection with appropriate antibiotics.

Patients presenting to the ED with phimosis as a complication of balanitis should receive the following care:

• Without damaging the glans penis, dilate the foreskin using a clamp. If the glans penis is adherent to the foreskin, the procedure may be contraindicated. Local anesthesia, analgesia, and/or sedation may be required.
• Dilate the foreskin opening.
• Perform a dorsal slit incision by cutting the foreskin over the dorsal shaft of the penis to enlarge the foreskin opening. This procedure requires local anesthesia and, possibly, sedation.
• Perform a formal circumcision (preferably in the operating room).

Also see Reiter Syndrome

eMedicine.com. Balanitis. Last Updated: March 25, 2005