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Clinical Summary

Balanoposthitis is an infection and inflammation of the glans penis that also involves the overlying foreskin (prepuce). Balanitis is isolated to the glans, whereas posthitis involves only the prepuce. Pain, erythema, and edema of the affected parts of the penis are typically present. Patients may refrain from urination secondary to dysuria, or the edema may induce meatal occlusion, leading to urinary retention or obstruction. Common etiologies include overgrowth of normal bacterial flora secondary to poor hygiene (pediatric patients), STIs (adolescents and adults), and candidal infections (the elderly or immunocompromised).

Management and Disposition

Treatment is directed at the suspected etiology. Warm soaks and topical antibiotics (mupirocin) are the mainstay of therapy for infectious etiologies owing to poor hygiene. Counsel parents about proper cleansing and handling of the prepuce. Oral or IV antibiotics may be indicated if there is an accompanying cellulitis or urinary tract infection. If urinary obstruction is present, attempt catheterization using a small catheter. If catheterization is unsuccessful, urologic consultation for emergent surgical correction of the prepuce is required. Candidal infections are treated with meticulous hygiene and topical antifungal agents.

Pearls

  1. The inability to retract the foreskin completely is normal in boys up to the teens. Counsel parents that the prepuce should never be forcibly retracted. Attempting to do so could cause a paraphimosis, a true emergency.

  2. Placing the child in a bathtub with warm water will help alleviate difficulty with micturition assuming that no obstruction is present.

  3. Candidal balanitis or balanoposthitis may be indicative of an undiagnosed immunocompromised state, including diabetes.

FIGURE 8.39

Balanoposthitis. Note the erythema, localized edema, and significantly constricted preputial orifice of the distal penis. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 8.40

Balanitis. Candidal balanitis in an elderly patient with no other complaints. New-onset diabetes was diagnosed. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 8.41

Balanoposthitis. This toddler presented with physiologic phimosis, inflamed distal foreskin, dysuria, and swelling of the glans. (Photo contributor: James Palma, MD.)

FIGURE 8.42

Balanoposthitis. Candidal balanoposthitis in an uncircumcised man. (Photo contributor: Alan Storrow, MD.)

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