Help please for 4.5 yo son with mild pain

[Mommy Cat]

Hi -- I'm not sure where to turn so am posting for some advice.  My 4.5 yo son is intact and has no history of UTIs.  His older (8 yo) brother is also intact.  DS has never fully toilet trained;  he can't make it through the night without a wet diaper (which I understand is not a problem) and has accidents during the day, even when prompted to follow a regular schedule of using the bathroom.

Last night and early this morning DS complained that his penis hurt.  Not necessarily when voiding (but it hurt then too).  His pain did not seem to be severe (unlike the time that my 8 yo had a UTI) but as he had also complained once over the weekend I decided to bring him in to see his pediatrician.

The appointment started with a urine sample that tested negative;  it is being sent to a lab for further testing for UTI.  Unfortunately the ped (not his normal Dr., but one of 4 in a practice and one we have seen before) retracted him before I could say anything. I was kind of looking off to the side when she did it and was shocked because this has never happened before and his regular ped knows not to do that.  Also, she left him retracted and pulled his underwear up.  She interpreted his distress as a need to void so we went to the bathroom where I helped him slowly push his foreskin back in to place.  He also urinated a bit.

The glans was quite red, according to the ped abnormally so.  She said that he was infected and prescribed an anti-fungal cream (not sure which one as I haven't filled the prescription yet).  

She said that he developed an infection due to moisture present following urination.  She said he must retract to urinate and then allow the glans to dry before 'unretracting'.  She said he needs to apply this cream directly to the glans for 10 days.

Now I realize that if he *does* have an infection we don't know if it is a bacterial infection or a yeast infection because she didn't swab.

I know that her course of treatment is not appropriate, but what should I do?

She also referred us to a urologist for the incontinence issues.  I will note that he had wet his pants a tiny bit when we returned home from the visit and he had just emptied his bladder at the start of the visit (for the urine sample) and again a bit when we went to the bathroom after the retraction.  Then, about an hour later, his pants were wet again and he didn't seem to realize this when I pointed it out to him.

I feel awful for how the ped handled things.  I failed to do any research before the appointment (so I didn't know about swabbing without retraction) but I had gotten to a certain comfort level with this practice.  Ugh.

Thanks for reading;  I would appreciate any advice about what to do next.

[MCatLvrMom2A&X]

First I would tell your regular ped what happened and how she left your ds retracted which could have lead to a very serious problem with paraphimosis.
After what she did to him I wouldnt trust anything else that came out of her mouth honestly because she obviously has no idea about the intact penis.


I wish I could be more specific but without that swab it is impossible to tell exactly what the problem might be. Can you take him to your regular Dr. and get a swab done?

I think that the problem he is having with holding his urine is developmental and not an infection honestly. It sounds like he just isnt quiet there yet on the potty training road so I wouldnt see a urologist about it unless you suspect something is wrong on the inside with his kidney's or bladder.

Be aware as well that after her retraction of him and the leaving of the foreskin back he might develop some pretty bad irritation from it. My head is still spinning about her leaving it retracted that way

[Mommy Cat]

Thanks so much for the response.  

My instinct is not to visit the urologist and see how things evolve (which is normally my approach with most things.)

I think that at this point I will wait for the results of the urinalysis (tomorrow) and then call and speak to his regular ped

I will also tell both of my sons not to let anyone retract them (esp. my 8 yo).  Probably should have done that before but I didn't really think it would be an issue.