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An 8yo boy presents with dribbling urination and pain with urination. When he urinates he sees his foreskin balloon out. On exam, he has phimosis. Per parents, they were previously able to retract his foreskin for hygiene purposes, but now they can’t. The patient is able to urinate and ultrasound shows no significant post-void residual. He is afebrile and urinalysis does not show evidence of UTI.
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March 3, 2020 at 10:44 am
E) Discharge with topical corticosteroid cream and close follow-up
The patient has pathologic phimosis because he previously had a retractable foreskin. His phimosis also leads to ballooning of the foreskin with urination, and retained urine could put him at risk for UTI and balanitis. However, since he does not have urinary retention at this time, a trial of outpatient therapy is warranted. The treatment of choice to attempt to medically resolve the phimosis is topical corticosteroids and gentle stretching of the foreskin. Betamethasone or triamcinolone are commonly used topically daily for 4-6 weeks. Physiologic phimosis is common, particularly in young children < 5 years old, and if there are no complications such as ballooning, recurrent balanitis, UTI, or urinary retention, no treatment is needed.