Balanitis and Balanoposthitis

(1)

Pediatric Surgery, Al Azher University, Cairo, Egypt

Abstract

Balanitis is an inflammatory disease affecting the glans penis, and it usually discussed by dermatologists and overlooked by many surgeons. But as many cases may complicate penile surgeries; like circumcision, also these cases may need differentiation from other similar surgical diseases and congenital anomalies. Repeated attacks of balanitis and/or balanoposthitis may be complicated with surgical conditions, which necessitate intervention; like phimosis and meatal stenosis.

Keywords

BalanitisBalanoposthitisCandida balanitisHuman papilloma virusTrichomonal speciesAnaerobic infection

Balanitis is an inflammatory disease affecting the glans penis is usually discussed by dermatologists and overlooked by many surgeons. But as many cases may complicate penile surgeries; like circumcision, these cases may need differentiation from other similar surgical diseases and congenital anomalies. Repeated attacks of balanitis and/or balanoposthitis may be complicated with surgical conditions, which necessitate intervention; like phimosis and meatal stenosis.

39.1 Balanitis

Definition

Balanitis is inflammation of the glans penis, when the foreskin is also affected, it is termed balanoposthitis. Balanitis of boys still in diapers must be distinguished from trivial redness caused by ammoniacal dermatitis. The word comes from the Greek “βάλανoς” balanos, which means “acorn”.

39.1.1 Incidence

Balanitis is a common condition affecting 11 % of adult men seen in urology clinics and 3 % of children in the United States; globally, balanitis may occur in up to 3 % of uncircumcised males [1]. Many cases also reported after circumcision, specially in early postoperative period.

Several organisms and viruses can cause balanitis, including the following:

Candidal species (most commonly associated with diabetes).
Group B and group A beta-hemolytic streptococci.
Neisseria gonorrhoeae.
Chlamydia species.
Anaerobic infection.
Human papilloma virus.
Trichomonal species.
Rare pathogens like; Borrelia vincentii and Borrelia burgdorferi.

Mayser has proposed that candidal balanitis/balanoposthitis is the most frequent mycotic infection of the penis [2]. Incontinent children, specially those with spina bifida, may had a severe form of candida, or a mixed infection of balanoposthitis secondary to chronic irritation and bad hygiene (Fig. 39.1).

Fig. 39.1

Candida balanitis affecting the glans of a circumcised 1 year old boy

Specific types of balanitis; like Balanitis xerotica obliterans (BXO), and plasma cell balanitis (Zoon balanitis) had been discussed in Chap. 37.

39.1.2 Symptoms

Patients with balanitis usually present with the following complaints:

Urethral discharge.
Pain or difficulty with retraction of foreskin.
Difficult urinating or controlling urine stream (in very severe cases).
Inability to insert a Foley’s catheter.
Tenderness and erythema of the glans penis.
Itching.
Systemic symptoms such as fever and nausea are uncommon.

39.1.3 Physical Examination

Findings may include the following:

Erythema and oedema of glans penis or foreskin (Fig. 39.2).

Fig. 39.2

Erythema of the glans penis due to post-circumcision balanitis
Discharge.
Ulceration and/or plaques (Fig. 39.3).

Fig. 39.3

Deep ulcer in the glans penis, due to sever bacterial balanitis in a circumcised boy
Pathological or secondary phimosis (Fig. 39.4).

Fig. 39.4

Pathological phimosis secondary to repeated attacks of untreated balanitis or balanoposthitis
Ballooning of the foreskin with voiding.
Signs of urinary obstruction (rare).
Bladder distension.
Inguinal lymphadenopathy.

39.1.4 Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; with a subsequent reduction of preputial elasticity, which may lead to pathologic phimosis (Fig. 39.4).

Balanitis, if not discovered early and treated properly, it may also lead to meatal stenosis, urethritis and ascending UTI, specially in a circumcised child. In very few cases, it may contribute to the buried penis syndrome.

39.1.5 Management

Patients presenting with balanitis but without phimosis should be investigate to detect the causative organism, culture of discharge in complicated cases such as those with associated cellulitis should be done early. Appropriate antibiotic or anti fungal medication should start systemically, with an additive local treatment.

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