Balanoposthitis associated with the presence of subpreputial "smegma stones".

coitus. Examination revealed an inflamed, only partially retractable prepuce with a purulent subpreputial discharge. Adequate urethral swabs were unobtainable; however, a subpreputial swab for bacterial culture was performed and subsequently grew Proteus spp, Pseudomonas spp, coliform bacilli, anaerobes, and non-candida yeasts. Urine dipstick testing proved negative for sugar. He was prescribed fluconazole 150 mg immediately and metronidazole 200 mg three times daily for 1 week and advised to irrigate gently with normal saline under the prepuce. On follow up at 1 week there had been a marked improvement. The prepuce was now fully retractable, albeit with some difficulty. Urethral swabs were obtained for microscopy, chlamydia ELISA testing, and Neisseria gonorrhoeae culture all of which proved negative. On examination there was still evidence of erythema affecting the glans and prepuce but no obvious discharge. In addition, there was a large accumulation of smegma and three small "smegma stones" (fig). On further questioning he stated that he had never previously attempted to retract his foreskin and had therefore never washed the