Renal and Electrolytes
Betamethasone cream is the preferred treatment for primary, phimosis. Ballooning of the
foreskin when urinating is not an absolute indication for circumcision. Phimosis generally will
not cause urinary retention or interfere with the urinary stream, and it is not considered a
surgical emergency.

Secondary phimosis is an absolute indication for circumcision.

Cephalexin and warm soaks would be indicated for balanoposthitis.

Manual reduction of the paraphimosis is imperative, Surgery if unsuccessful. The use of
hyaluronidase under the narrowed band or 20% mannitol can be helpful, may need a dorsal
incision in the constrictive ring.
The first step in evaluating a pediatric patient with severe acute HTN is to confirm the BP
reading manually with the correct size cuff (cuff width should cover 70% of the upper arm
and the bladder length should be 80% to 100% of the arm circumference) and location
(centered between the acromion and olecranon).

Main causes of secondary HTN are Cardiac, Renal and Endocrine.

Antihypertensive medication should be administered to achieve a 25% reduction in mean
arterial pressure over 8 hours to avoid complications such as stroke, retinal ischemia,
myocardial infarction, and renal failure.
Phimosis and Paraphimosis
Nitrite testing has poor sensitivity, particularly in infants who empty their bladder frequently,
but high specificity. In contrast, leukocyte esterase is much more sensitive than specific.

Simple cystitis will usually be cured with a brief course (4-5 days) of antibiotics, but febrile
UTI or pyelonephritis should be treated with 10 to 14 days of antibiotic therapy.

For children with severe dysuria, phenazopyridine can be used to alleviate pain. Use should
be limited to short courses (less than 48 hours) to avoid risk of hemolysis and

The definition of positive urine culture is more than 50,000 colony forming units/mL on a
suprapubic or catheterized​ specimen, or 100,000 in a properly clean catch specimen.