Balanoposthitis in children
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of balanoposthitis in a child
- Diagnostics
- Treatment of balanoposthitis in a child
- Possible complications and consequences
- Forecast
- Prevention
Balanoposthitis in children is an inflammatory process in which the head of the penis and the inner leaf of the preputial sac are affected. Balanoposthitis is recorded in about 6% of male children who have not undergone circumcision. Most often, the disease is diagnosed in children under 5 years of age. The foreskin at this age still covers the head of the penis, which contributes to the development of the disease.
Balanoposthitis is diagnosed in about 6% of boys under 5 years of age
Causes and risk factors
The main reasons for the development of balanoposthitis in children include the lack of proper hygienic care for the genitals. This causes the accumulation of smegma under the foreskin (the secretion of the sebaceous glands of the foreskin, mixed with the exfoliated cells of the epidermis of the head of the penis), which is a favorable environment for the reproduction of microorganisms with the subsequent development of the inflammatory process. Children 3-5 years old are especially susceptible to balanoposthitis, who have a physiological or congenital narrowing of the foreskin, which does not allow completely exposing the head of the penis (phimosis). They also contribute to the onset of a pathological process of synechia of the foreskin (a pathological process in which there is fusion between the epithelial layers of the glans penis and the foreskin,the head of the penis is not exposed or is only partially exposed).
The most common infectious agents for balanoposthitis in children are staphylococci, streptococci, Escherichia coli, Proteus, microscopic yeast-like fungi of the genus Candida, herpes virus.
The development of balanoposthitis in children is facilitated by infectious agents - streptococci, staphylococci, Proteus, Escherichia coli, etc.
In some cases, balanoposthitis in children also develops as a result of excessive use of hygienic procedures of the genitals - too frequent washing of the head of the penis with soap causes skin irritation, and subsequently its inflammation.
The disease can also manifest itself against the background of allergic reactions to baby cream, the remains of washing powder on linen, household chemicals, etc.
Balanoposthitis in babies can develop with a rare change of diapers or with the wrong selection (diapers that are too tight or too large in size). In older children, the disease can be caused by wearing too tight underwear, constant trauma to the foreskin with seams on the underwear.
Often, balanoposthitis in children develops against the background of endocrine disorders (overweight, diabetes mellitus), diseases of the genitourinary system (pyelonephritis, cystitis, urolithiasis), liver cirrhosis, and heart failure. Risk factors also include hypothermia and vitamin deficiency.
Forms of the disease
Balanoposthitis can be acute or chronic.
In acute, in turn, the following forms are distinguished:
- simple (catarrhal);
- erosive;
- pustular and ulcerative;
- gangrenous.
Symptoms of balanoposthitis in a child
Balanoposthitis in childhood develops sharply. The child complains of itching, burning sensation in the genital area, difficulty and soreness during urination. Small children in the process of urination become restless, cry. On examination, hyperemia and swelling of the glans penis and foreskin are noted, while under the foreskin accumulated smegma with an unpleasant odor is found, abundant serous-purulent or cheesy discharge from the preputial sac is possible. On the skin and mucous membrane of the genital organs, small punctate rashes, diaper rash or cracks are often found. With a far-reaching inflammatory process, erosion develops, areas are observed where the surface layers of the skin are exfoliated.
In addition to local symptoms, general symptoms of balanoposthitis in a child appear, caused by intoxication: deterioration of the general condition, irritability, moodiness, loss of appetite, sleep disturbances. Body temperature can rise to subfebrile values (38 ˚С). Due to attempts to retention of urination, children with balanoposthitis often develop nocturnal and / or daytime enuresis.
children with balanoposthitis often develop enuresis
In the absence of timely adequate treatment, balanoposthitis in children becomes chronic, which can lead to the formation of scars on the foreskin with the possible development of deformation of the head of the penis. Severe inflammation is accompanied by the development of inguinal lymphadenitis, which is manifested by an increase in the inguinal lymph nodes.
The clinical picture of the disease varies depending on the form of balanoposthitis. With catarrhal inflammation, surface erosions of various sizes are observed, which, as the pathological process develops, are prone to merging with each other, maceration of the skin of the head of the penis and foreskin, purulent discharge.
With the erosive form of balanoposthitis, areas of dead epithelium of white color are found on the affected area, on which painful red erosions are then formed with a pronounced rim of maceration along the edge. This process is accompanied by fever, and a sharp pain in the inguinal lymph nodes may appear.
With a pustular-ulcerative form, pustules form on the foreskin and the head of the penis, which then turn into deep ulceration.
With the gangrenous form, the intoxication of the body is expressed, the body temperature rises, and deep ulcerations appear at the site of erosion, covered with a purulent bloom. At the same time, the foreskin can be perforated, damage to the blood vessels can lead to bleeding.
Diagnostics
If you suspect balanoposthitis, an examination of the child by a pediatric surgeon or a pediatric urologist is required. In most cases, instrumental examination is not required, the diagnosis is made on the basis of data obtained from the study of complaints and anamnesis, an objective examination of the patient, as well as laboratory tests:
- general urine analysis (leukocytosis and bacteriuria are detected);
- bacteriological examination of urine and discharge from the preputial sac in order to identify the pathogen;
- enzyme immunoassay and polymerase chain reaction study also to determine the pathogen (if a viral infection is suspected).
In the general analysis of urine with balanoposthitis, leukocytosis and bacteriuria are revealed
Treatment of balanoposthitis in a child
In the case of self-opening of the preputial cavity and its cleaning from pathological contents, self-healing of the patient is possible.
In most cases, local therapy is sufficient to treat balanoposthitis in children. Baths with antiseptic solutions (furacilin, potassium permanganate) or decoctions of medicinal herbs, instillation of antiseptic solutions under the foreskin are used. In the event that it is impossible to bare the head of the penis on your own, the procedure is performed by a pediatric surgeon or urologist.
To relieve pain and relieve puffiness, nonsteroidal anti-inflammatory drugs are prescribed inside. In severe cases of infectious balanoposthitis in children, general therapy with sulfonamides, antibiotics, antiviral or antimycotic drugs may be required.
With balanoposthitis in children, therapeutic baths with furacilin are shown
With the transition of the disease to a chronic form, as well as with the development of phimosis, surgical excision of the foreskin (circumcision, circumcisio) may be required. The operation is performed on an outpatient basis, under local or general anesthesia. Sometimes the foreskin is expanded by applying a clamp. This procedure is performed by a urologist under local anesthesia. A contraindication to surgery is fusion of the foreskin with the glans penis.
When treating balanoposthitis in a child, the correct toilet of the genitals is important.
After the cure of a simple and erosive form of the disease, there are no scars on the genitals; in the case of gangrenous and pustular-ulcerative balanoposthitis, deep scars may remain after healing, and deformity of the penis may develop.
Possible complications and consequences
When the infectious process spreads to the urethra, urethritis develops. In addition, lymphadenitis (inflammation of the lymph nodes), lymphangitis (inflammation of the lymphatic vessels), urosepsis, etc. are possible.
The most serious complications of the disease include paraphimosis, in which there is an infringement of the head of the penis by the pathologically narrowed foreskin.
Forecast
With timely diagnosis and a properly selected treatment regimen, the prognosis is favorable. Some forms of the disease in weakened children may recur or become chronic.
Prevention
In order to prevent balanoposthitis in children, it is recommended:
- carry out regular and correct toilet of the genitals of young boys;
- teach the child to self-adhere to the rules of personal hygiene;
- promptly treat diseases that can cause or a risk factor for inflammation of the glans penis or foreskin;
- carefully select and timely change diapers for babies;
- choose the right underwear for the child, monitor its timely change;
- maintain a normal body weight.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
