A 5yo uncircumcised boy comes in because his parents are unable to retract the foreskin of his penis. They have not been able to retract it ever, but now note also that he is having ballooning of the foreskin when he urinates. On exam, the opening of the foreskin is very tight. Appropriate treatment includes:
A. Forceful retraction of the foreskin to break any adhesions
B. Topical steroid cream and close follow-up
C. Topical estrogen cream and close follow-up
D. Emergent consultation with a urologist for immediate circumcision
E. Reassurance that the condition will resolve by age 10 years
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March 7, 2017 at 7:06 am
By school-age should be able to retract the foreskin – Topical steroid creams have been shown in randomized trials to be quite effective >90%
March 7, 2017 at 10:40 am
B) topical steroids and follow up with good return precautions
March 8, 2017 at 3:12 pm
Absolutely correct! Answer is B. The patient has phimosis, which is often normally seen in infants and toddlers, but which usually resolves by age 5 years. Forceful retraction should never be done, as it can cause scarring. A trial of topical steroid e.g. triamcinolone 0.1% for 6-8 weeks will often promote resolution. The patient can be referred to a pediatric urologist non-emergently if phimosis and ballooning are persistent after topical steroid therapy.