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What is A 5 year old child pulls penis skin while urinating. Upon examination there is erythema and edema over the prepuce. Diagnosis: and explain in detail?
Ans. (d) PhimosisRef Bailey 2&h ed. /1359PHIMOSIS* Phimosis is a condition in which the contracted foreskin cannot be retracted over the glans.* Chronic infection from poor local hygiene is its most common cause.* Most cases occur in uncircumcised males, although excessive skin left after circumcision can become stenotic and cause phimosis.Clinical features* Difficulty in micturition is the main symptom.* Ballooning of prepuce during micturition is suggestive of phimosis.* Edema, erythema, and tenderness of the prepuce and the presence of purulent discharge usually cause the patient to seek medical attention.* Inability to retract the foreskin is a less common complaint.HYPOSPADIAS* Hypospadias results when fusion of urethral folds is incomplete, and urethral meatus opens on the underside of penis or perineum (ventral surface of penis).* Because fusion of urethral folds is from posterior to anterior, Anterior forms are more common than posterior.* Associated pathology: in addition to ventrally placed ectopic meatus, hypospadias has:# Chordee: ventral curvature of penis due to contracture of fibrous cord which has replaced the distal urethra and corpus spongiosum.# Hooded prepurce: deficient on ventral aspect and excess on dorsal aspect# Stenosis of ectopic meatusEPISPADIAS* Urethra opens on the dorsum (upper aspect) of the penis in males, in females there is a fissure in the wall of the urethra which opens above the clitoris* Females: Bifid clitoris and separation of the labia. Most are incontinent because of maldevelopment of the urinary sphincters.* Males: Patients with glandular epispadias seldom have urinary incontinence. However, incontinence in penopubic epispadias is 95% and penile epispadias is 75%.POSTERIOR URETHRAL VALVE* Exclusively an anomaly of male urethra.* Symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.* Newborns may present with palpable abdominal masses.* Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.