Urology

Question 1

What is balanitis?

Answer 1

Inflammation of the glans penis

Question 2

What are the symptoms of balanitis?

Answer 2

Sore swollen glans penis.
Phimosis (note phimosis is often physiological)

Depending on the cause there may be:
Penile ulceration (small red erosions)
Penile plaques 
Satellite lesions
May be purulent and/or foul-smelling discharge
Dysuria

Question 3

What investigations should be done in balanitis?

Answer 3

BM as more common in diabetics.

Swab of discharge if present.

Question 4

What is an important cause of balanitis which needs to be considered and what is it?

Answer 4

Balanitis xerotica obliterates (BXO).

It is an often progressive autoimmune condition (‘lichen sclerosis of penis’) in which patches of white atrophic thickened patches of skin occur on the glans penis, foreskin and meatus.
Causes pathological phimosis

Question 5

How does BXO present?

Answer 5

White patches on the glans or prepuce.
Soreness, haemorrhagic blisters.
Dyspareunia, painful erections due to phimosis.
If there is meatal scarring, poor urinary stream or dysuria.

Question 6

How is balanitis treated?

Answer 6

Local hygiene and topical or oral antibiotics.

If an STI needs alternative antibiotics.

BXO patient will need circumcision due to the phimosis caused by the scarring.

Question 7

What are the medical indications of circumcision?

Answer 7

Phimosis
Paraphimosis
Recurrent balanitis
BXO

Question 8

What are the risks of circumcision?

Answer 8

Haemorrhage 
Infection
Meatal stenosis
Secondary phimosis
Adhesions between the shaft and glans penis

Question 9

Describe when a phimosis can be considered as physiological?

Answer 9

In preschool children it is not unusual for there to be thin adhesions to the glans causing a physiological phimosis.

At age 3 years about 10% of boys are unable to retract the foreskin but, by adolescence all boys should be able to achieve retraction.

Question 10

What are labial adhesions?

Answer 10

Labial adhesions (also referred to as labial agglutination) are a common disorder in prepubertal females (3months to 3 years)Labial adhesions can often be managed with periodic observation; spontaneous resolution may occur and commonly occurs during puberty.

Question 11

How do you treat labial adhesions?

Answer 11

Often managed conservatively with periodic observation; spontaneous resolution may occur and commonly occurs during puberty.

If this is not achieved the child can have surgical separation.