Balanitis Treatment & Management
- Author: Mark J Leber, MD, MPH; Chief Editor: Erik D Schraga, MD more...
Emergency Department Care
Patients presenting with balanitis but without phimosis should receive the following recommendations and treatment:
- Gentle retraction of the foreskin daily and soak in warm water to clean penis and foreskin.
- In pediatric patients and patients with mild balanitis xerotica, a 2-month trial of antifungals may be attempted; the patient or mother should retract the foreskin gently and apply 0.05% betamethasone twice a day. This applies to children older than 3 years. Success is seen particularly in male children older than 10 years compared with those aged 3-10 years. Success ranges from 65-95%.
- Topical steroids have had only limited success in patients with moderate-to-severe balanitis xerotica obliterans. These patients are more likely to have distal scarring of the foreskin.
- In recurrent cases, 1% pimecrolimus cream was used instead of steroids, with a 64% success rate.
- Apply bacitracin (not Neosporin) for pediatric patients if bacterial infection is suspected.
- Apply topical clotrimazole for adult men with probable candidal balanitis.
- Obtain a culture of discharge in complicated cases such as those with associated cellulitis, then treat empirically with appropriate antibiotics (typically first-generation cephalosporin).
- A study of 1185 boys concluded that fluticasone proprionate 0.05% was effective and safe in treating associated phimosis, with successful results in 91.1% of patients.
Patients presenting to the ED with phimosis and severe urinary obstruction as a complication of balanitis should receive the following care (recommended that surgical intervention be performed by a urologist, if available):
- Steroid cream and gentle retraction of the foreskin, if the phimosis is not too tight, may be used before surgery is contemplated.[13, 14]
- Without damaging the glans penis, dilate the foreskin using a clamp. If the glans penis is adherent to the foreskin, the procedure may be contraindicated. Local anesthesia, analgesia, and/or sedation may be required.
- Perform a dorsal slit incision by cutting the foreskin over the dorsal shaft of the penis to enlarge the foreskin opening. This procedure requires local anesthesia and, possibly, sedation.
- Perform a formal circumcision (preferably in the operating room).[15, 16]
- Circumcision is not a preventive treatment of balanitis in those younger than 3 years.
Consult a urologist if a dorsal slit incision or circumcision is contemplated.
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