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Phimosis

Phimosis

Question:

- My baby has small pouches with pus in the penis. After the pediatrician unplugged her hand, these bags continued to appear. I wash it with chamomile and give it an antibiotic (sumetrolim). Do you think it will pass?

Answer:


Inflammations located in the penis are known as balanitis (inflammation of the penile gland) and balanopostitis (inflammation of the penile gland and foreskin).
These inflammations are usually the result of bacterial or fungal overinfection of smegma - the local secretion that accumulates as a result of a deficiency of local hygiene or due to the existence of local conditions: phimosis or balano-preputial adhesions.
Balanopreputional adhesions (adhesions between the glans and foreskin) are quite common in children under 2 years of age and may be congenital or secondary to repeated local infections; in turn, the presence of these adherents favors local infections, thus creating a vicious circle that maintains the recurrence of infections.
Phimosis is defined by the existence of a narrow preputial orifice that does not allow for descaling. Between the foreskin and the glans there may be tight adhesions and smegma may accumulate, which predisposes to infections.
Phimosis can be: congenital (it can be considered physiological up to the age of 5 years), it can appear as a result of local infections or after the forced descaling that injures the foreskin and leads to the formation of nonelastic scars resulting in the final phimosis.
Other possible causes of balanitis and balanopostites are allergies to detergents or linen.
Clinically, there is spontaneous pain that can be exacerbated when urinating and reaching the gland and foreskin, these being edematized (swollen), erythematous (red) and at the level of the preputial orifice the presence of purulent secretion can sometimes be noticed. General phenomena like fever, chills are rarely associated with balanopostitis, but may occur if urinary tract infection is associated.
The treatment consists of: local debridement (if not associated with phimosis, mild lysis of the balanopreputal adhesions is practiced if they exist, decalotation, removal of smegma), local antiseptic baths (with chamomile tea or betadine) 3-4 times a day, application of antibiotic ointments or oral administration of an antibiotic. If edema is important, steroid ointments may be associated.
Usually, if the treatment is followed correctly, this infection should be resolved within 7-10 days. In the case of children in whom phimosis is present or who have presented at least 2 balanopostite kits, the circumcision is indicated; this is done only after the infection has been cured and after the local inflammatory reactions have been remitted.
I advise you to follow the doctor's treatment and directions: if the infection persists and after the treatment is over, ask a new pediatrician (a bacteriological examination of the purulent secretion may be helpful in choosing an antibiotic targeted on the etiologic agent of the infection).
After remission of the inflammation you should consider a consultation with a pediatric surgeon, who can determine the need for a circumcision, to prevent further infections.
Alina Pop-Began
- Resident physician - Anesthesia and Intensive Care -

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