Penile Problems in Pediatric

Phimosis

Phimosis is a tightness of the foreskin so that it cannot be drawn over the glans. It is most logically defined as either physiological or pathological. Physiological phimosis occurs because of the inability to retract infantile foreskin, owing to congenital adhesions between the glans and foreskin. By age 2–3 years, these adhesions break down and retraction becomes possible. However, around 6% of boys still have physiological phimosis at age of 10–11 years. 

Phimosis

Pathological phimosis occurs when the foreskin cannot be retracted after it has previously been retractable. Clinically this results in ballooning of the foreskin during urination. There may be mild obstruction to urinary flow or recurrent balanitis. Circumcision may be recommended if any of these pathological conditions are present.

Paraphimosis

Paraphimosis is a clinical condition that occurs when the foreskin is retracted and remains proximal to the glans penis. In this position the foreskin becomes progressively swollen due to vascular obstruction and may actually strangulate the glans. This situation will occur after forced retraction of the foreskin (e.g. for catheterization) or vigorous cleaning. If allowed to persist, increasing edema makes reduction progressively more difficult. The usual treatment is manual reduction. A local anesthetic block of the dorsal nerve of the penis is inserted. The foreskin is compressed to reduce the edema and then the foreskin is reduced by pressure on the glans.

Paraphimosis

Treatment depends on the age and degree of discomfort that the child is experiencing. If the swelling has been present for a prolonged period, then reduction may need to be under conscious sedation. Rarely reduction with accompanying circumcision under general anesthetic is required.

Posthitis/balanitis

Posthitis (inflammation of the prepuce) is more common than balanitis (inflammation of the glans). It is less common in children than in adults. In most cases the cause is infectious in origin although contact irritation, allergy and trauma may also be contributing factors. 

The treatment is directed towards the causative organism obtained by swabbing and culture. Mild cases usually respond to twice daily baths with gentle retraction of the foreskin along with a topical antibiotic ointment such as Polysporin. In more severe cases (inflammation involving more than a third of the shaft of the penis), treatment is usually with an oral broad spectrum antibiotic that is effective against uropathogens and staphylococcus (e.g. amoxycillin and clavulinic acid). This is in addition to cleaning and regular baths. These latter simple measures can prevent the recurrence of balanitis.