Clinical History and Presentation
A 2-year-old Latino male presented to the primary care office with a one-day complaint of irritability and penile swelling. A Spanish translator was obtained for the parent interview. The patient had no recent illness, changes in appetite, or recent fevers. There was no known trauma to the abdomen or genitals.
The child's medical history was unremarkable, with an uncomplicated term pregnancy and no history of chronic illness, previous surgeries, or hospitalizations. The child lived at home with his parents and two school-aged sisters. His parents were poor historians and were unable to provide a family history. The child's immunizations were up to date. He had no known allergies and was on no routine medications. The review of systems was negative except as noted above. His growth and development were normal for age. His height was 34.25 inches, weight was 26.9 pounds (12.2 kg), and body mass index (BMI) was 16.1 kg/m2 (37th percentile). His vital signs were within normal for age: temperature 36.8° Celsius axillary, blood pressure 84/58, pulse 120 beats per minute, and respirations 24 breaths per minute.
On examination, the child appeared in no acute distress. He had no skin rash or lymphadenopathy. His abdomen was soft, non-tender, and non-distended with no hepatosplenomegaly. There was no ecchymosis noted to the abdomen or the genitals. The child was uncircumcised, with both testicles descended. The foreskin was semi-mobile with moderate erythema and swelling (ballooning) of the prepuce; the meatus was barely visible. The glans penis was moderately erythematous and edematous with the appearance of phimosis. Upon gentle palpation of the penile shaft, a large amount of mucopurulent discharge was easily expressed from the urethra and from under the foreskin. The child did not complain of pain with palpation of the penis or expression of discharge. The remainder of the physical exam was unremarkable.
Urol Nurs. 2018;38(5):237-239. © 2018 Society of Urologic Nurses and Associates