Paediatric Acute care Guidelines PMH Emergency Department

Balanitis is a irritation and inflammation of the foreskin and glans, often associated with poor hygiene. There is usually an infective component to the condition, and there may be an associated nappy rash.

Balanitis is an irritation and inflammation of the foreskin and glans, often associated with poor hygiene. There is usually an infective component to the condition, and there may be an associated nappy rash.

Background

  • Incidence 4%
  • Usually seen in boys less than 4 years

Assessment

  • Mild to severe swelling of the foreskin and glans
  • Erythema

Investigations

  • No investigations are required

Differential diagnoses

  • Paraphimosis

Management

Initial management

If the patient is still able to void urine:

  • Oral antibiotics – Cephalexin or co-trimoxazole (e.g. Bactrim)
  • Chloromycetin ointment topically 3 times a day  (Bactroban is a reasonable alternative)
  • Twice daily salt baths
  • Referral to Surgical Outpatients only if recurrent episodes

If the patient is unable to void urine:

  • Refer to Paediatric Surgical Team 
  • If the bladder is full, consider “in-out” urinary catheterisation to empty bladder. Try to avoid an indwelling catheter if possible.
  • IV or oral antibiotics
  • Twice daily salt baths

Medications

Referrals and follow-up

  • If doubt exists about the diagnosis of balanitis, or there is paraphimosis, seek an urgent surgical opinion.

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