Penile swelling is often a sudden condition which is alarming to the patient and parents, invariably prompting a visit to the emergency room or clinical office. Its presence can cause embarrassment and fear of difficulty with urination or sexual dysfunction. Pain may or may not be associated with the development of penile swelling. The penile skin and prepuce are unique tissues in their ability to stretch and tolerate trauma. The elastic and nonrigid nature of these tissues allow for interstitial fluid to accumulate readily and cause edema. The penile skin normally has a subtle, rugated appearance, and edema produces a tight and stretched appearance.

The causes of penile swelling can be determined by a thorough history and physical examination. Laboratory tests and/or radiological studies are rarely necessary to evaluate penile swelling. With careful assessment and implementation of appropriate treatment, the physician caring for a child with penile swelling can rapidly affect clinical improvement and emotional reassurance for the child and the family.

Penile swelling may be a primary (localized to the penis) or secondary (systemic) process, and it may occur in the circumcised or uncircumcised penis. If penile swelling is a secondary process, underlying causes may include renal, cardiac, hepatic, or gastrointestinal problems. Penile swelling is almost always present in anasarca, and may also occur as dependent edema in bedridden patients or patients postoperatively. On rare occasions, penile swelling may be the first sign of a systemic allergic reaction to certain medications. In these patients, the term angioedema is used to describe diffuse swelling of the loose subcutaneous tissues in addition to the dermis. This reaction can occur with or without urticaria. Lymphedema of the penis may be the first manifestation of Crohn disease. Congenital genital lymphedema is recognized in infancy by the thickened and leathery appearance of the penile skin and scrotum, particularly the prominent scrotal raphe, in the absence of erythema. This condition is secondary to abnormal lymphatic drainage and may occur with or without lower extremity involvement.

Primary causes of penile swelling, whether from infection, inflammation, or trauma, will present acutely, and tend to be more anxiety-provoking for the family. Many of the primary causes of penile swelling occur in association with edema, erythema, pain, and, in some cases, suppuration. Certain types of penile swelling, such as paraphimosis and posthitis, occur only in the uncircumcised male. The assessment of symptom duration, pain, erythema, and, importantly, the ability to urinate are the first steps in the assessment of penile swelling.

• There may not be a clear history of trauma in infants or toddlers.

• The toilet seat can fall on the penis of the young child who is trying to hang the penis over the edge of the toilet, causing trauma to the penis.

• Traumatic penile injuries are likely to be painful causes of penile swelling. Patients may report bruising along the shaft, scrotum, and perineum.

• Traumatic injury may be associated with difficulty urinating.

• Patients may not have a known history of an insect bite, which can result in penile swelling.

• Surgery in the pelvic area may result in painless dependent edema.

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