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Question: GU

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Parents bring in their 18 month old uncircumcised son because of concern regarding a bump on his penis. He has no other symptoms and is afebrile. They first noticed it 3 days ago and it is unchanged. On exam there is a 3-4mm diameter pearl-like white mass under the prepuce (distal foreskin). It is not fluctuant or tender. The child is phimotic, and the foreskin can be retracted to visualize the meatus, but not fully retracted. 

What is the next best step of management?

pemsou5_wp • December 12, 2023

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  1. Kelly December 13, 2023 - 11:25 am Reply

    E) Reassure the parents and discuss general hygiene for uncircumcised boys
    The description is consistent with a “smegmoma,” which is formed by a collection of desquamated epithelial cells trapped under the foreskin. Other terms used are: preputial cyst, preputial pearl, keratin pearl, smegma pearl. These are benign and no further work-up or treatment beyond a discussion of basic hygiene is needed. Topical corticosteroids are used to treat problematic phimosis, but phimosis is expected at this age, and is not causing problems with voiding.

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