Management of Pediatric Penile Problems in the Emergency Department (Trauma CME and Pharmacology CME)

Publication Date: June 2026 (Volume 23, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 06/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Trauma CME credit and 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Kyna Donohue, MD

Pediatric Emergency Medicine Fellow, University of San Diego Pediatrics and Rady Children’s Hospital, San Diego, CA

Kathryn Pade, MD

Associate Professor of Pediatrics, Rady Children’s Hospital, University of California San Diego, San Diego, CA

Abstract

Pediatric penile problems range from congenital anomalies to acquired and emergent conditions. Acquired conditions can result from various causes, including infectious and inflammatory conditions, hematologic conditions, strangulation conditions, trauma, and surgical injuries. This review provides an overview of the presentation, diagnosis, and management of pediatric penile problems that may present to the emergency department. Recommendations are given for evaluation and management, with emphasis on pain relief, restoration of normal anatomy, and timely treatment. Guidance is also provided on indications for emergent urologic consultation. Optimizing outcomes for pediatric patients with penile conditions requires addressing key challenges, including effective pain and anxiety management, thoughtful use of imaging, and careful evaluation for possible abuse.

Case Presentations

CASE 1

A 3-day-old boy presents for persistent bleeding after circumcision completed 8 hours earlier…

The boy was born at full term with no complications. The parents tell you the circumcision was completed without complications at the delivering hospital prior to discharge. Since the procedure, they have seen a “significant amount” of bright-red blood with each diaper change. They have been applying petroleum jelly as directed. There is no family history of bleeding diatheses. The baby received vitamin K after delivery. The newborn screen is pending.
On examination, there is a small amount of bright-red blood dripping from the circumcision site.
What workup is warranted at this time, and what are the next steps in management?

CASE 2

A 4-year-old uncircumcised boy presents with the complaint of penile pain for the last 4 days and difficulty urinating for the last 24 hours...

The boy has no prior history of urinary tract infections. He is toilet-trained. His parents report dribbling of urine for the last few days and inability to void when attempting to urinate.
On examination, there is edema and ballooning of the foreskin of the penis. The foreskin is unable to be retracted to visualize the tip of the penis; however, there is scant discharge from the end of the penis. There are a few erythematous “satellite lesions” on the inguinal creases. His urine is positive for 1+ leukocytes and negative for nitrites.
What is the appropriate management for this patient?

CASE 3

A 14-year-old uncircumcised boy presents with penile pain, swelling, and difficulty urinating for the last 12 hours...

The boy takes no medications and denies being sexually active.
The physical examination is notable for a donut-shaped, erythematous, and exquisitely painful circumferential swelling at the base of the glans, with moderate swelling of the glans and flaccidity proximal to it. There is no discharge.
What pain control measures and techniques should be considered for management of this patient’s condition?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.