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A boy aged was seen after 48 hours of penile pain and retention of urine. In the past a non-retractile foreskin had been noted but there had been no previous episodes of balanitis. On examination, there was ballooning and erythema of the foreskin over the glans penis. After intravenous antibiotics, examination under anaesthesia revealed frank pus within the foreskin (which later yielded a growth of Escherichia coli). The phimotic foreskin was retracted, a dorsal slit was performed, and the bladder was emptied via a 6F paediatric feeding tube (Figure 1). The child left hospital next day with a prescription for a week of oral antibiotics. At outpatient review the wound had healed; the parents then opted for circumcision.
Acute urinary retention secondary to balanitis-phimosis has not, to our knowledge, been described previously. We have found one report of chronic retention (with bilateral hydroureteronephrosis and vesicoureteral reflux) from this cause, with nocturnal enuresis as the presenting symptom.3 For management we favour the dorsal slit4 since it relieves the acute urinary obstruction, facilitates the drainage of pus and preserves the foreskin. Furthermore, emergency circumcision is technically difficult because of the gross oedema and it carries a greater risk of postoperative infection.