​Kembara Xtra - Medicine - Balanitis, Phimosis, Paraphimosis

​Kembara Xtra - Medicine - Balanitis, Phimosis, Paraphimosis 
GENERAL FACTS 
An inflammation of the glans penis is known as balanitis.
- Foreskin or prepuce inflammation is referred to as posthitis.
- Balanoposthitis is an inflammation of the foreskin and glans penis.
- Balanitis xerotica obliterans (BXO) is an unusual glans penis lichen sclerosus.
Paraphimosis and phimosis Phimosis is a condition in which the distal penile foreskin is too constrictive to allow it to be pulled back from the glans. A retracted foreskin becomes bloated and engorged, which prevents it from returning to its position over the glans, causing paraphimosis, or constriction by the foreskin of an uncircumcised penis; Urologic emergency 
Renal/urologic, reproductive, and skin/exocrine system(s) affected

ALERT: Phimosis can develop as a result of recurrent infection and irritants (condom catheters).
A chemical or viral recurrent balanitis might develop into an acquired phimosis.
The improper forceful reduction of a physiologic foreskin, which is frequently carried out on the advice of medical professionals, can result in acquired phimosis and chronic scarring. 
If neglected, paraphimosis is a pediatric emergency that can result in necrosis and autoamputation.

EPIDEMIOLOGY Phimosis/paraphimosis: prevalent age: infancy and adolescence; unusual in adults; risk returns in geriatrics; predominant sex: male only Balanitis: predominant age: adult; predominant gender: male only Incidence
Balanitis: 3–11% of guys will develop it.
Prevalence
Phimosis affects 1% of men over 16 and 8% of youngsters under 6 in the United States.

Etiology and pathophysiology of lanitis include allergic reactions to contraceptive jelly, latex, and soaps as well as infections with Trichomonas, Candida albicans, Borrelia vincentii, Streptococcus, and HPV. - Fixed-drug eruption (tetracycline, sulfa).
- Infiltration of plasma cells (Zoon balanitis)
- Autodigestion by exocrine enzymes from activated pancreatic transplants Phimosis - - Physiologic: present at birth; resolves on its own between the ages of 2 and 3 thanks to nocturnal erections that gradually widen the phimotic ring. - Acquired: repeated foreskin inflammation, damage, or infections Paraphimosis: - Frequently iatrogenic or unintentionally brought on by the foreskin not being put back over the glans after urinating, cleaning, having a cystoscopy, or inserting a catheter Aspects of Geriatrics
Balanitis may be predisposed by condom catheters.
Child Safety Considerations
Oral antibiotics increase the risk of Candida balanitis in male babies.
The majority of phimosis referrals seen in pediatric urology clinics are foreskins that are normally phimotic physiologically. By repeatedly forcing the foreskin down, improper treatment of physiologic phimosis might result in acquired phimosis. Uncircumcised penises don't need any particular maintenance, and with proper hygiene, the majority of foreskins will eventually become retractile.

Balanitis risk factors include: foreskin, morbid obesity, poor hygiene, and diabetes, which is likely the most prevalent.
- A nursing facility setting - Condom catheters
- Chemical allergens
- Nephrosis, CHF, and other edematous diseases Phimosis, poor hygiene, and diabetes brought on by recurrent balanitis
Infants who frequently develop diaper rash or posthitis may also have paraphimosis, which is caused by an untrained medical professional leaving the foreskin retracted after inserting a catheter. - Lack of knowledge regarding foreskin care

Balanitis general prevention - Adequate hygiene and avoidance of allergens
Phimosis/paraphimosis: - Circumcision In order to prevent phimosis and paraphimosis if the patient is uncircumcised, proper hygiene and care of the foreskin are required.

DISEASE HISTORY
Balanitis symptoms include: pain, drainage, dysuria, odor, ballooning of the foreskin while voiding, and redness.
Phimosis: - Excruciating erections
Foreskin balloons when urinating; recurrent balanitis.
Paraphimosis: - Uncircumcised - Pain - Drainage - Voiding problems - Inability to retract foreskin at the right age

Balanitis physical examination: erythema, tenderness, edema, discharge, ulceration, plaque
Phimosis: Inability of the foreskin to retract.
Physiologic phimosis: the preputial orifice appears healthy and normal. Secondary balanitis.
Preputial orifice features a delicate, white fibrous ring of scarring due to pathologic phimosis.
Edema of the prepuce and glans, drainage, and ulceration

Balanitis: DIFFERENTIAL DIAGNOSIS: - Psoriasis, Reactive arthritis (formerly known as Reiter syndrome), Lichen planus, and Leukoplakia - Sclerosus and atrophic lichen
Erythroplasia of Queyrat (BXO): atrophic alterations at foreskin's end that can form a ring that hinders retraction 
Paraphimosis and phimosis: - Penile lymphedema, which can be brought on by allergic responses, trauma, or bug stings. - Hair is the most prevalent foreign body surrounding the penis in penile tourniquet syndrome. The Anasarca

DETECTION & INTERPRETATION OF DIAGNOSIS

Initial examinations (lab, imaging)
Microbiology culture; Wet mount; Syphilis serology; Blood sugar; ESR (if reactive arthritis is a problem); STI testing; HIV testing; Gram stain; Diagnostic Procedures/Other Biopsy, if persistent

CONTROL / GENERAL MEASURES
For recurring balanitis and paraphimosis, think about having your child circumcised. 
Local sanitation

MEDICATION
- Allergic/irritant: Balanitis
1% BID Hydrocortisone
- Antifungal: 1% BID of clotrimazole (Lotrimin).
 BID-QID Nystatin (Mycostatin)
Fluconazole: a single 150 mg PO dosage
- Bacitracin QID, an antibacterial
Neosporin (Neomycin-Polymyxin B-Bacitracin) QID
If cellulitis, administer a parenteral or oral cephalosporin or sulfa medication. Dermatitis: QID for topical steroids
Topical steroids QID for zoon balanitis
Phimosis: 0.05% fluticasone propionate once a day for 4 to 8 weeks with gradual foreskin traction; 1% pimecrolimus once a day for 4 to 6 weeks; not for usage in children under 2 years of age. 
If at all feasible, manually reduce the paraphimosis (perform this when the patient is sedated). The engorged skin near the glans should be touched with the middle and index fingers of both hands. Attempt reduction by placing both thumbs on the glans and applying light pressure to the glans while pulling on the foreskin. If that doesn't work, a dorsal slit will be required, followed by final circumcision once the edema goes down.
Osmotic drugs relieve edema by applying granulated sugar to swollen tissue for several hours. 
With several holes made in the foreskin using a 21-gauge needle, edematous fluid might escape, leading to decrease.
A surgeon or urologist performs a dorsal slit. BXO: 0.05% betamethasone BID and 0.1% tacrolimus BID

THE REASONS  FOR REFERENCE
occurring again or meatal stenosis developing

SURGICAL PROCEDURES 
Consider circumcision as a preventative measure for phimosis and balanitis.
To treat paraphimosis: - Is a true surgical emergency to prevent glans necrosis. If reduction is not achievable, there are two options: - Operative exploration - Dorsal slit with delayed circumcision. - If the risk of penile tourniquet syndrome cannot be completely ruled out. In the event that a hair is suspected of being the source of the tourniquet, hair removal lotion might be administered.

CONSIDERATIONS TO ADMIT THE PATIENTS 
Initial stabilization of uncontrolled diabetes and sepsis as admission requirements; Appropriate cleanliness if condom catheters are used; Discharge after resolution of problem


CONTINUING CARE AFTER CARE RECOMMENDATIONS
Balanitis Patient Monitoring:
Every 1 to 2 weeks until the cause has been identified. A biopsy may be necessary for persistent balanitis to rule out BXO or cancer.
 Weight loss if obese and evaluation for phimosis resolution

PATIENT EDUCATION Avoid recognized irritants like soaps for two to three weeks after circumcision, as well as the need for proper cleanliness and foreskin care.

PROGNOSIS Should Be Treatable with the Right Medicine

CONDITIONS Meatal stenosis, persistent irritation-induced premalignant alterations, urinary tract infections (UTIs), acquired phimosis, and irreducible paraphimosis can all result in gangrene.

Posthitis (prepuncal inflammation)