Intermintine itch

My 10 yr. old son was born with hypospadias. His first surgery at 6 mo. seemed to fix the problem. after some time we noticed there was still leaking from the original uretha. The Doctor said it was a fistula which required a second surgery. To make a long story short he ended up with having a total of 3 sugeries before the problem was fixed. Now within the last year he has been complaining of an itch that comes and goes. He says it feels like it is in the opening of the uretha and it is so bad he cries. We have been to our GP and three oter Dr's in our office.The first one said it was just an itch and to put cortizone cream on it. The second on ran a urine test and there was so much blood and protien in it it could not be counted under a microscope. He diagnosed it as a uti but when it was tested further nothing happened. He took the antibiotics prescribed and everything was O.K. for about a month and it returned. Dr. # 3 did same test, but no  blood this time, only protien. She advised us to have an ultrasound and another test done to make sure we wern't dealing with reflux. Everything came back normal. A couple of months went by and again the itch came back. Dr. #4 said he thought the opening of the constructed uretha looke a little larger than it would have normally been had he not had the hypospadias. He seemed to think this was causing his penis to be extra sensitive and that's what was causing the itch. All of the Drs. have said they don't see any signs of a yeast problem either. My son still is having problems with the itch. the last time it looked as if the tip of his penis was a little red and scaly. It is very frustrating for all of us. Do you have any ideas as to what is causing this and what we can do to fix it?

[Kevin Pho, MD]

If 4 physicians cannot come up with a diagnosis, it is unlikely that I can come up with anything new without examining the patient.

Infection needs to be ruled out - culturing the urethral for bacteria and yeast should be done.  Antibiotics for bacteria, or an antifungal for a fungal infection, can be considered if present.  

If infection has been appropriately evaluated for, you can consider stronger corticosteroids to treat for a dermatitis.  A referral to a dermatologist can be considered to evaluate this possibility.  

You can consider another opinion at a major academic medical center if the workup remains non-revealing.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

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