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I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

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Friday, 8 May 2015

Penile Problems

Penile problems in children


Hypospadius
Correct before 2 years of age. Do NOT circumcise as may need reconstructive surgery

Phimosis
- At 1 year old 50% boys have non-retractile foreskin, by 4yrs 10% and by 16yrs only 1%
- Non-retractile foreskin = balooning on micturition
- Topical corticosteroids can help.
- Encourage patients to maintain good hygiene and gently stretch the foreskin.

Emergency if causes acute urinary retention

Paraphimosis
Foreskin gets stuck in the retracted position.
Look for a hair tourniquet.
May be secondary to masturbation
Needs analgesia to reduce

Balanoposthitis
Balanitis = cellulitis of the glans
Posthesis = cellulitis of the foreskin

Can be irritant, bacterial or fungal.

Management
Needs warm baths
Rule out diabetes
Clotrimazole or antibiotic ointment
Normally get oral amox or trimeth too


References
http://emupdates.com/2009/04/01/900-balanitis-vs-balanoposthitis-causes-of-balanoposthitis-rx-conditions-prevented-by-circumcision/
http://www.wikem.org/wiki/Phimosis
http://emupdates.com/2009/04/01/899-management-of-phimosis-paraphimosis-causes-consequences-treatment/ 
http://www.bmj.com/content/346/bmj.f3678?sso= 
http://www.emrap.tv/index.php?option=com_content&view=article&id=106
http://www.wikem.org/wiki/Balanoposthitis
http://www.amazon.co.uk/Illustrated-Textbook-Paediatrics-STUDENTCONSULT-Online/dp/0723435650

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