Balanoposthitis

Balanoposthitis (inflammation of the glans and the foreskin) is a frequent condition seen in the clinic. Usually caused by external irritation from soaps, antiseptic washing solutions or repeated retraction of foreskin. The presentation is usually with pain, redness, swelling, dysuria and sometimes discharge. Child is often reluctant to urinate. 

True urinary obstruction from balanoposthitis or balanitis complicated by meatitis is unusual. If pain interferes with urination, then the patient will often be able to void after application of topical lidocaine 

Treatment of irritant contact balanitis or balanoposthitis includes 

• Withdrawal of the precipitating agent (eg, soaps, detergents, etc) 
• Application of aqueous emollient cream, and topical, low-potency corticosteroid therapy, such as hydrocortisone 1 percent cream applied sparingly twice daily for seven days. Topical corticosteroids should only be initiated if the clinician is sure that no concomitant infection exists
• Irritation and inflammation may be relieved with Sitz baths. Encourage such children to urinate into warm water-bath.

Empirical use of topical antibiotic ointment can be used to prevent secondary bacterial infection or if clinical suggestion of bacterial infection is seen

(Polysporin or Bacitracin) four times daily or mupirocin cream twice daily. Ointments that contain neomycin may cause contact dermatitis and should be avoided. Topical antibiotics are also an important treatment for patients with traumatic balanitis or balanoposthitis. 

A short course of oral first-generation cephalosporin may be given in severe cases

Discourage forced retraction of the foreskin. 

Rarely, circumcision is required for recurrent balanoposthitis.

The patients with the following presentations warrant referral to a pediatric urologist

• Acute urinary obstruction
• Prolonged or refractory disease course (eg, persistent noninfectious conditions despite several weeks of local care and good hygiene or patients with infectious conditions who have completed a course of targeted antimicrobial treatment without relief of symptoms)
• Recurrent balanoposthitis or development of true phimosis (scarring with inability to retract the foreskin)