Balanitis is a common inflammatory condition in men caused due to infections, trauma and poor personal hygiene. The inflammation is caused on the head of the penis also called as the glans penis. The region of glans penis along with the foreskin becomes inflamed. This condition is rare among men who are circumcised. Many underlying infections induce the onset of balanitis. One of the most common causes of balanitis is poor personal hygiene. In this case a layer of creamy substance called smegma is formed under the foreskin causing balanitis. Men who are circumcised rarely suffer this condition.
Phemosis is a condition in which the foreskin cannot be retracted. This condition predominantly happens in boys at the age of four. The urine collecting under the foreskin along with debris may lead to balanitis.
Candidiasis is one of the major causes of balanitis. In most cases candida associated balanitis is caused because of trauma and it also referred as circinate balanitis.
Many other infectious organisms like Streptococcus.Sp, Staphylococcus aureus (Steven Johnson's syndrome) cause balanitis. Most of these organisms cause infections in uncircumcised persons who do not clean the glans penis region on a regular basis. Balanitis is also sexually transmitted. Men are generally advised to clean their genital areas after intercourse, to prevent balanitis. Balanitis is also caused because of certain soaps or disinfectants used in washing the glans region. In some cases, use of spermicides and lubricants present in the condoms can induce balanitis.
Balanitis symptoms begin with the appearance of rash on the glans region. In some cases these rashes progress into more predominant sores leading to discharge with odor. In these cases the region behind the glans penis is also affected. Other associated symptoms of balanitis include joint pains, malaise and soreness of the mouth. The classic clinical presentation of balanitis includes the presence of ulcerated glans tissue, edema, leukoplakia, exudation and also crusting. Untreated balanitis is often associated with the development of meatal stenosis and also malignancy leading to painful discharge and localized lymphadenopathy.
Risk Factors for Balanitis: The risk factors associated with the occurrence of balanitis includes diabetes and trauma. In case of diabetics who are uncircumcised, the urine droplet accumulation leads to serious infections along with balanitis. In some cases balanitis risk factor is also reported among sexual partners affected by vaginitis. The other factors include obesity, chemicals and reaction to certain group of drugs.
Treatment of Balanitis
Balanitis treatment is often associated with personal hygiene. Men who are uncircumcised and are prone to frequent episodes of balanitis are advised to wash and dry the glans penis region every day and especially after intercourse to prevent infections which may lead to balanitis. Diabetics are advised to keep a regular check on their sugar levels especially pertaining to urine sugar levels to prevent the onset of balanitis.
Antibiotics and steroidal creams are generally prescribed for this infection. In some cases ibuprofen and acetaminophen are given to relieve the pain. In case of recurrent balanitis, removal of foreskin (Circumcision) is suggested. Patients undergoing treatment are advised to abstain from sexual activity until the treatment is completed to prevent relapse.
Urethrogram is a diagnostic procedure to examine the urethra. Genital Urethrogram is almost always carried out on male patients with symptoms such as dribbling of urine, sense of incomplete bladder emptying, hesitancy, poor stream, urinary urgency, urinary frequency, poor bladder emptying etc.
In many patients, the most prominent indication is potential urethral stricture disease. Genital Urethrogram is an essential tool for doctors for careful examination of the images followed by best interpretation so as to plan appropriate course of treatment. In males, the urethra is the tube that caries urine and semen through the penis, outside the body. Genital Urethrogram involves taking an X-ray of the tube. Measuring 20 cm in length, there are two divisions:
Anterior ( penile and bulbar)
Posterior ( membranous and prostatic)
What is Genital Urethrogram ?
The diagnostic X-ray procedure, Urethrogram is done to study the urethra. It can be either retrograde Urethrogram or antegrade urethrogram. It may take 30-60 minutes for completion of the procedure. Depending on the need to examine the anterior or posterior urethra, either of the two is done.
Retrograde Urethrogram (RUG): Ascending study to assess the anterior urethra which is composed of the penile and bulbar urethra.
Antegrade Urethrogram: Descending study to assess the posterior urethra which is composed of the membranous and prostatic urethra.
Why do Genital Urethrogram ?
Doctors recommend Genital Urethrogram when patients express problems with poor urinary flow or problems passing urine. In older men, the reason can be attributed to enlargement of the prostate. But in young and middle aged males and male children, it might be a history of injury, infection etc.
The procedure throws light on two major aspects of the urethra. Firstly, the capacity of the bladder and its emptying ability and secondly, examination of the urethra, the narrow tube which connects the bladder to the genitals through which urine passes before leaving the body.
Indications of Genital Urethrogram
Infection: Gonococcal Urethritis, non-gonoccocal urethritis
Inflammatory: Balanitis Xerotica obliterans
Trauma: Straddle injury, pelvic fractures
Iatrogenic: Instrumentation, prolonged catheterization, trans-urethral resection of the prostate, open radical prostatectormy, urethra reconstruction.
On the appointed day, the patient is admitted in the hospital radiology department or radiology practice where the procedure is to be done. The patient will be asked to empty the bladder and put on a hospital gown. He is made to lie on an x-ray table called a fluoroscopy table in a specific position. Sterile drapes are placed over the lower body. The penis and groin will be cleaned with an antiseptic solution. A narrow catheter or a thin plastic, silicone or rubber tube will be placed into the end part of the penis from where the urine exits. A small balloon will be inflated in order to keep the catheter in place and to stop contrast medium (special dye) running out of the end of the penis.
Contrast medium is gently injected into the urethra by placing a catheter at the top of the penis. As the bladder is filled with the contrast, the patient is likely to experience some discomfort. There can be an urgent need to pass urine. At this point, the catheter will be removed. The final images of the bladder will be taken.
The X-ray table will be tilted. The patient is now in a standing position. A bottle will be handed over to pass urine. When the patient is passing urine, x-ray pictures of the bladder and the urethra will be taken to understand how well the bladder empties. The images also pin-point if there is any narrowing in the urethra.
After completion of Genital Urethrogram, it is normal to notice some blood at the tip of the penis. The patient may experience some discomfort or stinging at the end of the penis where the catheter was inserted and the balloon was inflated. This will subside after passing urine few times on the same day or the next day. The urine can be with small amount of blood too.
Are there risks associated with Genital Urethrogram ?
Three potential risks have been identified but all the three are rare instances. Allergic reaction to the dye (contrast medium), urine infection and damage to the urethra are the three possible risks associated with Genital Urethrogram. Of the three, urine infection and allergic reaction are easily manageable.
Prior to the procedure, the patient must inform the medical team if he is allergic to iodine-containing contrast. With regard to urinary infection, if it does not subside even after 36 hours of the procedure, it is best to seek medical attention. Antibiotics will be prescribed. Damage to the urethra is also rare but might occur if Genital Urethrogram is performed as an emergency procedure. In some cases, emergency surgical repair is recommended. The surgery aims at restoring urethral function and near-perfect cosmetic appearance.
Bibliography / Reference
Collection of Pages - Last revised Date: January 20, 2019