Monday Back to Basics

Pediatric Penile Pain with Dr. Edward Guo

​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.
ParaphimosisEntrapped 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

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