Balanitis

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff with the assessment and management of balanitis.

Definition

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

Management

If the patient is 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.      

Bibliography

  1. AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
  2. Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier
  3. Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier 

Endorsed by:  Director, Emergency Department  Date:  Jan 2018


 Review date:   Jan 2021


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