Common and Emergent Problems of the External Genitalia

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Common and Emergent Problems of the External
Genitalia
Dominic Frimberger, M.D. Associate
Professor Pediatric Urology Childrens Hospital of
Oklahoma OU Health Science Center
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Pediatric Urology

• Testis
• Hernia/ Hydrocele
• Undescended testis
• Varicocele
• Epididymitis/ Orchitis
• Torsion
• Testis
• Appendix Testis
• Tumor

• Penis
• Phimosis
• Paraphimosis
• Adhesions
• Buried penis
• Penile pain
• Hypospadias

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Pediatric Urology

• Female Genitalia
• Labial adhesions
• Mucosal polyp
• Imperforate hymen
• Tumor
• Trauma
• Infection

• Other
• Disorders of sexual development (DSD)
• Bladder/Cloacal Exstrophy
• Sexual abuse

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Penile Development

• At birth
• Prepuce retractable in 4
• Meatus can be seen in 50
• 6 month of age
• Prepuce retractable in 20
• 3 years of age
• Prepuce retractable in 90
• Minor adhesions present
• Puberty
• Almost all completely retractable

Kaplan G, Urol Clin 1983
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Phimosis

• Phimosis
• Prepuce cannot be retracted over the glans penis
• Physiologic Phimosis
• Pliant, unscarred preputial orifice
• Pathologic Phimosis
• Failure to retract secondary to distal scarring
  of the prepuce

Leonard M, 2007
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Pathologic Phimosis

• Occurs mostly by forcefully pulling back the
  prepuce in infancy
• Scarring after Infection
• Failure of the phimotic preputial ring to retract
  after childhood

Osburn et al, Pediatrics 1981
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Forceful Retraction
PAIN
Glans becomes raw with bleeding
Real Adhesions will form
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Result Everybody is MAD
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Solution

• No forceful retraction of the prepuce
• If no retraction at all after 5 years or scarring
  is present from previous attempts
• Betamethasone dipropionate 0.05 cream
  (Diprolene) no FDA approval under 16 years of
  age
• Most important Parent education about the
  natural process
• Handouts
• Perform circumcision on parents request

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Paraphimosis

• Tight preputial ring is trapped behind the glans
  after retraction
• Very painful
• Edematous preputial skin and glans
• Urinary retention
• Requires immediate attention
• Pain
• Possible necrosis
• Management
• Compression
• Dorsal slit

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Balanoposthitis

• Balanitis (inflammation of the glans)
• Posthitis (inflammation of the foreskin)
• Antibiotics
• No surgery in acute inflammation
• Circumcision versus conservative treatment
• Often causes later adhesions or phimosis