Balanitis xerotica obliterans.

Twenty patients with histologically proven balantis xerotica obliterans have undergone different forms of treatment; their progress has been reviewed and discussed. Balanitis xerotica obliterans involving only the foreskin was best treated by circumcision. The patients in whom meatal stenosis was present responded well to regular meatal dilatation, meatotomy followed by regular dilatation and, in advanced cases, to meatoplasty. At present there is no evidence to indicate that associated urethral strictures, proximal to the fossa navicularis, are due to balanitis xerotica obliterans.     

Balanitis xerotica obliterans in children.

Balanitis xerotica obiterans is a chronic inflammatory process in male subjects, resulting in sclerotic epithelial changes of the glans penis, prepuce and urethral meatus individually or collectively. Four pediatric cases are presented, including the first case of balanitis xerotica obiterans invloving the glans penis and urethral meatus in a child. This lesion may be misdiagnosed or ignored in the young boy. The suggested method of treatment is surgical extirpation of the lesion when possible, wedge meatotomy when needed and sublesional corticosteroids if the lesion cannot be completely excised.     

Balanitis xerotica obliterans in children

This report is based on 7 children with balanitis xerotica obliterans. Of these patients 5 had stenosis of the urethral meatus that required meatotomy and the postoperative results were good. The frequency of balanitis xerotica obliterans in children at our center, as well as the findings of other authors, suggests that possibly more cases would be diagnosed during infancy if all dried foreskin were examined systematically.     

Balanitis xerotica obliterans involving anterior urethra

Seventy patients with clinically localized prostatic carcinoma were studied for histologic differentiation of primary tumor and the incidence of lymph node metastasis. Also the urologic literature was reviewed regarding the survival of such patients under similar treatment. The results indicate that clinically staged A2 tumors are more aggressive biologically than tumors staged as B1, reaffirming the need for a change in the current staging system. The authors propose reclassification of clinically unsuspected, diffuse carcinoma from the A to the B2 stage.     

Balanitis xerotica obliterans: surgical treatment

A case of BXO treated with complete surgical removal of the mucosal lesion and skin flap meatoplasty with excellent results 26th months later is reported.     

Balanitis xerotica obliterans involving anterior urethra

Balanitis xerotica obliterans (BXO) is known to affect the urethral meatus, glans, and prepuce. We describe a case of biopsy-proved BXO that involves not only the usual areas but the anterior urethra as well. Of added interest is the subsequent development of squamous cell carcinoma in the fossa navicularis. The literature is reviewed.     

Die topische Therapie der Balanitis xerotica obliterans im Kindesalter

Balanitis xerotica obliterans (BXO) is a chronic and progressive dermatitis of unknown aetiology and incidence. Its management in childhood is controversial. Although in most cases only the prepuce is affected, meatal and urethral involvement may lead to major surgical reconstruction. Therefore complete surgical excision of the affected skin is considered to be mandatory. In case of involvement, incidental histological evidence or a relapse, or when complete removal of the affected skin is not possible, a topical therapy should be implemented. In a retrospective analysis of our study population (13 children) with BXO, relapse rate was lower after topical therapy with tacrolimus (Protopic), a highly selective immune modulator, than after the standard anti-inflammatory therapy with betamethasone. The use of tacrolimus ointment is a safe therapy with no severe side effects. Due to the fact that there are no predictive factors for progression or relapse of BXO, we consider a topical anti-inflammatory therapy is always indicated after any type of surgery for BXO. Follow-up monitoring should be close, so that any relapse can be detected and treated as early as possible.     

Posthitis xerotica obliterans in circumcision specimens

Histologic examination of foreskins submitted from circumcisions in patients with phimosis revealed 22 cases of posthitis xerotica obliterans from 1956 to mid-1973. From 1970 to 1973 a tabulation of all specimens showed the exact incidence of this entity to be 3.6 per cent. Fifteen of 22 cases found were in children less than thirteen years of age, the youngest being four years. There was a correlation of the histologic severity of the changes of posthitis xerotica obliterans with the severity of clinical symptoms. A 32 per cent incidence of urinary obstructive changes was noted.     

Penile lichen sclerosus (balanitis xerotica obliterans)

What's known on the subject? and What does the study add? The clinical presentation and complications of lichen sclerosus are well known. What is less well known is the true incidence of the condition. The published figures are all based on attendance at general medical clinics or specialist clinics, but it is likely that the true incidence is much higher than this reported incidence as many men will not present to the doctor for treatment. The other uncertainty is the relationship of lichen sclerosus to the subsequent development of cancer of the penis. As pointed out in the paper, it is likely that between 4% and 8% of men with this condition will develop squamous cell cancer of the penis. However, it is unclear if lichen sclerosus itself causes the development of squamous cell cancer or if it is due to coexistent infection with human papillomavirus. This review provides a concise summary of the clinical and pathological features of the disease and describes its current medical and surgical treatment. It brings together a number of papers which have addressed the association of lichen sclerosus with squamous cell carcinoma of the penis and shows that the likely incidence of carcinoma is approximately 4-8% in men with this condition. SUMMARY: Penile lichen sclerosus, also known as balanitis xerotica obliterans, is a chronic inflammatory condition of the penis which can occur at all ages. The inflammation leads to the formation of white plaques most commonly on the foreskin or penis, and can lead to inability to retract the foreskin or blockage to the flow of urine. Cancer may occur rarely. Penile lichen sclerosus is a progressive, sclerosing, inflammatory dermatosis of the glans penis and foreskin which is of uncertain aetiology. Recent studies have shown a link between lichen sclerosus and squamous cell carcinoma of the penis. In this review, we discuss the clinical presentation, pathology and current approach to treatment of this condition.     

Continuous wave carbon dioxide treatment of balanitis xerotica obliterans

Herein is presented the first case of balanitis xerotica obliterans treated successfully by carbon dioxide-continuous wave (CW-CO₂) laser vaporization. This method appears to be a safe addition to other well-known treatment modalities, offering minimal postoperative discomfort, preservation of anatomic landmarks and function, and excellent cosmetic results.     

One-stage repair of hypospadias.

A new one-stage procedure for repair of penile hypospadias is presented. Seventeen cases have been performed with minimum complications. The steps of the procedure are described.