| Differential Diagnosis | Clinical Findings | Management |
| Balanoposthitis (cellulitis of glans or foreskin) | Glans, foreskin, or both are erythematous, tender, or edematous | Warm soaks +/- oral antibiotic or antifungal cream depending on etiology |
| Phimosis | Stenosis of distal foreskin preventing retraction of foreskin over the glans | Most uncircumcised infants have normal, physiologic phimosis that will spontaneously resolve by 5 years of age. Rarely requires treatment other than daily hygiene. Monitor for if foreskin completely seals off causing acute urinary retention – true emergency. |
| Paraphimosis | Entrapped ring of foreskin retracted proximal to glans of penis causing pain, erythema, and swelling | Consult pediatric urology emergently! In cases when urology is not immediately available or necrosis of penis is imminent, ED physician may attempt reduction. |
References:
– Liu DR. Pediatric Urologic and Gynecologic Disorders. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020
– https://www.uptodate.com/contents/balanitis-and-balanoposthitis-in-children-and-adolescents-management
