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Pediatrics May 2016As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of...
OBJECTIVE
As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated the incidence and morbidity of foreskin surgery due to medical indications in boys from the Capital Region of Denmark in 2014.
METHODS
Medical records from all boys operated on the foreskin due to medical reasons in the Capital Region in 2014 were reviewed. Patients with hypospadias, ritual circumcision, and redo-surgery because of complications to nontherapeutic circumcision were excluded.
RESULTS
A total of 181 patients were included. The cumulative risk of undergoing foreskin operation before 18 years of age was 1.7%. Forty patients had histologic verified balanitis xerotica obliterans (BXO) corresponding to a total risk of 0.37% of developing BXO. Mean age at surgery was 10.1 years (range 1-17). Phimosis was the most frequently reported indication (95.0%). The remaining 5.0% underwent surgery because of frenulum breve causing problems during erection. Before surgery, 27.1% had foreskin-related voiding problems and 17.1% had at least 1 episode of balanitis. Circumcision was initially performed in 44 cases. The remaining 137 patients had a foreskin-preserving operation performed. Nine boys had secondary circumcision after initially having foreskin-preserving operation. Fifty patients initially had preputial histology performed. BXO was verified in 37 patients. Of the 9 patients with redo-surgery due to recurrent phimosis, a further 3 had histologically verified BXO.
CONCLUSIONS
Childhood foreskin-related problems in a region with no tradition of newborn male circumcision should not be neglected.
Topics: Adolescent; Balanitis Xerotica Obliterans; Child; Child, Preschool; Denmark; Foreskin; Humans; Incidence; Infant; Infant, Newborn; Male; Phimosis; Retrospective Studies
PubMed: 27244821
DOI: 10.1542/peds.2015-4340 -
Folia Medica Cracoviensia Dec 2021Balanitis Xerotica Obliterans is a chronic, progressive, sclerosing inflammation of unclear etiology. It involves the external genitalia of males and more specifically...
Balanitis Xerotica Obliterans is a chronic, progressive, sclerosing inflammation of unclear etiology. It involves the external genitalia of males and more specifically the prepuce and its frenulum, the glans, and the external urethral meatus while it may extend to the peripheral part of the urethra. Recent studies have noted an increasing incidence in the paediatric population. It is the most common cause of secondary (pathologic) phimosis. Even more, in boys with physiologic phimosis that does not respond to conservative treatment, Balanitis Xerotica Obliterans should be considered as the underlying condition. In this study, we present all the latest data and attempt to create a diagnostic and curative algorithm regarding this condition.
Topics: Balanitis Xerotica Obliterans; Child; Circumcision, Male; Humans; Inflammation; Lichen Sclerosus et Atrophicus; Male; Phimosis
PubMed: 35180205
DOI: 10.24425/fmc.2021.140007 -
International Journal of Dermatology Oct 2016Lichen sclerosus (LS) is an uncommon idiopathic chronic inflammatory debilitating disease with predilection for the genital region. Our recent encounter with an LS case...
BACKGROUND
Lichen sclerosus (LS) is an uncommon idiopathic chronic inflammatory debilitating disease with predilection for the genital region. Our recent encounter with an LS case exhibiting perineural inflammation microscopically prompted us to assess the features of all patients diagnosed with LS at our institution.
MATERIALS AND METHODS
All cases of LS diagnosed between 1990 and 2014 were retrospectively reviewed. Diagnosis was confirmed with demonstration of microscopic features typical of LS.
RESULTS
Sixty patients (42 women and 18 men) with 65 biopsy specimens of LS were identified, of which 41 were extragenital, 16 genital, and three had both. Histopathologically, significantly higher proportions of follicular plugging, atrophy, and vacuolar interface changes were observed in extragenital LS cases, while angiokeratoma-like, mycosis fungoides-like, and pseudoepitheliomatous changes were only seen in genital LS. Perineural inflammation was observed as a novel finding in 22 cases (33.8%) of LS.
CONCLUSION
Features of patients with LS in this study are generally comparable to those published in the literature, with some differences. In contrast to the literature, extragenital LS was more frequently encountered. Histopathologically, perineural inflammation was not an uncommon feature of LS and thus may serve as a clue in the differentiation of LS from its mimickers.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Balanitis Xerotica Obliterans; Child; Extremities; Female; Head; Humans; Lebanon; Lichen Sclerosus et Atrophicus; Lupus Erythematosus, Systemic; Male; Middle Aged; Neck; Retrospective Studies; Scleroderma, Localized; Thyroiditis, Autoimmune; Torso; Vulvar Lichen Sclerosus; Young Adult
PubMed: 27229659
DOI: 10.1111/ijd.13336 -
Indian Journal of Plastic Surgery :... Jun 2023Clinical classification of the urethrocutaneous fistulas (UCFs) was designed to help the surgeons in (1) categorizing the fistulas, (2) selecting appropriate...
Clinical classification of the urethrocutaneous fistulas (UCFs) was designed to help the surgeons in (1) categorizing the fistulas, (2) selecting appropriate treatments, (3) keeping record at presentation and discharge, and (4) transferring information while referring a patient with recurrent fistula to a higher center. This retrospective study comprised of 68 patients with UCFs who reported in the "Hypospadias and VVFs Clinic" between 2004 and 2016. The study was performed to determine the incidence or etiology of the UCFs. It was rather performed to classify fistulas into different categories depending on the number of fistulas: A (5 fistulas), B (16 fistulas), C-a (28 fistulas), C-b (4 fistulas), D (4 fistulas), and E (11 fistulas). Category A fistulas healed conservatively. Category B fistulas underwent transection of the fistula tracts (tractotomy), purse-string closure, or multilayered closure (fistulorrhaphy). Category C-a fistulas were reenforced by preputial or penile skin flaps or waterproofing flaps. Category C-b fistulas underwent re-tubularization of their neourethral plates and eccentric closure of peno-preputial skin. The urethral plates of category D fistulas were re-tubularized after 3 to 6 months and cover was provided by the Cecil-Culp procedure. Category E fistulas had associated hairy urethra, stricture distal urethra, stricture with diverticulum, perifistular scar-induced chordee, long narrow urethral plate, balanitis xerotica obliterans (BXO), and short reconstructed neourethra. Accordingly, appropriate corrective measures were taken. Miscellaneous category F was excluded from the study. Except for one in category D, none of the patients had any recurrence of fistula. One patient of category E had residual diverticulum. The designed clinical classification of UCFs is simple. Treatment was in accordance with reconstructive ladder wherein complexity of treatment paralleled with increasing complexity of fistulas.
PubMed: 37435345
DOI: 10.1055/s-0043-1761598 -
Journal of Pediatric Urology Dec 2018The importance of the pathology of the dartos fascia in hypospadias and buried penis is still debatable. Understanding the properties of connective tissue of dartos... (Comparative Study)
Comparative Study
INTRODUCTION
The importance of the pathology of the dartos fascia in hypospadias and buried penis is still debatable. Understanding the properties of connective tissue of dartos fascia in hypospadias and buried penis may give a clue to the underlying mechanism.
OBJECTIVE
This study aimed to compare connective tissue and vascularization of dartos fascia between normal penis, buried penis, and hypospadias.
STUDY DESIGN
We conducted this prospective study from May 2013 to November 2016. We collected dartos fascia specimens from three groups: buried penis, hypospadias, and normal penis as control. All of the patients underwent primary surgery in all groups. Patients with penile abnormalities, such as phimosis or Balanitis Xerotica Obliterans (BXO) were excluded from the normal penis group. We compared the fibers between these groups using Masson trichrome histochemical staining, Gomori's silver impregnation staining, Weigert resorcin-fuchsin staining, and CD31 immunohistochemistry staining for evaluation of collagen fibers, reticulin fibers, elastin fibers, and endothelial cells of blood vessels, respectively. The collagen fibers, reticular fibers, elastic fibers, and vascular vessels were counted with ImageJ and manually calibrated and counted and were analyzed using the one-way ANOVA test. The assessment conducted by two pathologists was blinded, without knowing the clinical diagnosis of patients.
RESULTS
There was a total of 60 patients with 20 patients in each group. Collagen fibers for most cases of buried penis and hypospadias showed thicker but fewer collagen fibers than the normal penis. There was a reduction of total collagen and elastin of dartos fascia in hypospadias and buried penis cases. On the other hand, the ratio of reticulin fibers, which represents collagen type III to total collagen, was increased compared to normal penis.
DISCUSSION
Although the dartos fascia in buried penis and hypospadias is thick and inelastic when palpated or during traction/counter traction, it is well-vascularized tissue. This inelastic dartos fascia tissue is an abnormal tissue, but its characteristics are not similar to fibrotic tissue. However, further study with a larger sample is warranted and should differentiate the degree of chordee in patients with hypospadias and buried penis.
CONCLUSIONS
There was a difference between connective the tissue of dartos fascia in buried penis and patients with hypospadias compared with normal penis. Inelastic dartos fascia tissue in patients diagnosed with buried penis and hypospadias is an abnormal tissue. Therefore, it is suggested that this tissue is excised during reconstructive surgery. Further research is needed to unveil the pathophysiology of the condition.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Fascia; Humans; Hypospadias; Infant; Male; Penis; Prospective Studies
PubMed: 30554609
DOI: 10.1016/j.jpurol.2018.04.034 -
Acta Dermato-venereologica Mar 2017Lichen sclerosus is a chronic inflammatory disease associated with substantial morbidity. Knowledge of the aetiology and progression of lichen sclerosus is therefore...
Lichen sclerosus is a chronic inflammatory disease associated with substantial morbidity. Knowledge of the aetiology and progression of lichen sclerosus is therefore needed. In this cross-sectional study, 100 male patients diagnosed with lichen sclerosus were interviewed and examined. Since there is a possible link between lichen sclerosus and autoimmunity, blood tests were analysed for thyroid disease, antinuclear antibodies and antibodies to extracellular matrix protein 1, but autoimmunity was found to be infrequent. In 72 participants active genital lichen sclerosis was observed and complications were common; 27 patients had preputial constriction and 12 meatal engagement. In total, 13 patients needed a referral to the Department of Urology, including 1 patient with suspected penile cancer. In conclusion, despite available treatment with ultra-potent steroids and circumcision, lichen sclerosus in males is frequently complicated by phimosis and meatal stenosis. However, the disease can also go into remission, as seen in 27% of our patients.
Topics: Adult; Aged; Autoantibodies; Autoimmunity; Balanitis Xerotica Obliterans; Biomarkers; Circumcision, Male; Cross-Sectional Studies; Humans; Male; Middle Aged; Penis; Phimosis; Remission Induction; Retrospective Studies; Serologic Tests; Skin; Treatment Outcome; Urethral Stricture
PubMed: 27671756
DOI: 10.2340/00015555-2537 -
American Journal of Men's Health Sep 2018To evaluate the characteristics of lichen sclerosus (LS) accompanied by urethral squamous cell carcinoma (USCC) and to raise urologists' awareness about the early...
To evaluate the characteristics of lichen sclerosus (LS) accompanied by urethral squamous cell carcinoma (USCC) and to raise urologists' awareness about the early management of LS, a retrospective analysis was performed on the clinical features, diagnosis, treatment, and prognosis of 18 male genital LS accompanied by USCC patients who were referred to Shanghai Sixth People's Hospital between June 2000 and August 2014. All of the patients had a long-term history of LS, urethral strictures, and urethral dilatation. Seven patients are with distal (glanular or penile) USCC, 10 patients with proximal USCC, and one with entire USCC. The most common presentation, except for LS and urethral strictures, was periurethral abscess, followed by extraurethral mass, pelvic pain, urethrocutaneous fistula, hematuria, and bloody urethral discharge. All had primary surgical excision that was adapted to tumor location and extension. All of the USCC were positive for P53 and Ki-67. P16 was positive in four cases of human papillomavirus (HPV)-associated USCC and negative in 14 cases of HPV-independent USCC. Patients with distal USCC had a significant longer survival time than proximal USCC ( p < .05). LS should be treated early to prevent the disease progression. LS probably has some associations with USCC. Distal USCC has a relatively better prognosis than proximal USCC.
Topics: Aged; Biopsy, Needle; Carcinoma, Squamous Cell; Chemoradiotherapy; China; Cohort Studies; Comorbidity; Databases, Factual; Disease Progression; Follow-Up Studies; Humans; Immunohistochemistry; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Risk Assessment; Survival Rate; Tertiary Care Centers; Treatment Outcome; Urethral Neoplasms; Urologic Surgical Procedures, Male
PubMed: 29926751
DOI: 10.1177/1557988318782095 -
Malaysian Family Physician : the... Mar 2022Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision...
INTRODUCTION
Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision for physiological phimosis (adhesions). Due to parental concerns and misperceptions by general practitioners, non-retractile prepuce is one of the most common indications for referral to a paediatric surgeon in many countries. This study aimed to determine whether preputial adhesiolysis successfully managed symptomatic non-retractile foreskin and therefore prevented the need for circumcision.
METHODS
A retrospective review was performed of the health records of children who presented with preputial adhesion. We included 65 symptomatic patients (ballooning of the prepuce in all cases and additional dysuria in three cases) who underwent preputial adhesiolysis. All cases were followed up for 2 years. Circumcision was subsequently carried out for patients who developed fibrous scarring resulting in difficult retraction due to the development of thick adhesions or skin fissuring with persistence of symptoms.
RESULTS
Of the 65 boys, 58 (89.2%) achieved complete retraction of the prepuce. The remaining 7 boys (10.8%) presented with recurring symptoms and thick fibrosed prepuce, and they underwent circumcision due to the dense adhesions. Histopathological examination of the circumcised prepuces revealed balanitis xerotica obliterans in two cases.
CONCLUSION
Preputial adhesiolysis is a safe and effective treatment for symptomatic preputial adhesions in boys younger than 5 years old. The procedure avoids circumcision and its associated risks. Preputial adhesiolysis should be offered as a primary treatment instead of circumcision.
PubMed: 35440957
DOI: 10.51866/oa.27 -
Pediatric Dermatology May 2022Studies concerning pediatric lichen sclerosus are limited, and, to date, there have been no studies comparing the course of lichen sclerosus in boys and girls. We sought...
BACKGROUND
Studies concerning pediatric lichen sclerosus are limited, and, to date, there have been no studies comparing the course of lichen sclerosus in boys and girls. We sought to examine all publications on boys and girls with lichen sclerosus and assess and compare epidemiology, symptoms and signs, genetic background, risk factors, treatment, and prognosis.
METHODS
A systematic search was performed in the Embase, Medline, Cochrane, and Web of Science databases. Inclusion criteria were information on children ages 0-18 years and a clinical or histologic diagnosis of lichen sclerosus. Literature from 1985 to 2021 was reviewed.
RESULTS
A total of 1780 articles were retrieved from the search, of which 90 articles were eligible for inclusion. Boys and girls present similarly on many aspects; nonetheless, treatment and follow-up are approached differently.
CONCLUSIONS
Though the clinical approach is often different, lichen sclerosus in boys and girls demonstrates many similarities. More research is needed, especially on follow-up, to gain a better understanding of the course of lichen sclerosus and establish an advanced management plan for children.
Topics: Adolescent; Child; Child, Preschool; Female; Genetic Background; Humans; Infant; Infant, Newborn; Lichen Sclerosus et Atrophicus; Male; Prognosis; Risk Factors
PubMed: 35229894
DOI: 10.1111/pde.14967 -
European Journal of Pediatric Surgery :... Jun 2019Balanitis xerotica obliterans (BXO) is uncommon in children. Diagnosis of the condition is almost always clinical and supported by histology. Our aim was to evaluate...
INTRODUCTION
Balanitis xerotica obliterans (BXO) is uncommon in children. Diagnosis of the condition is almost always clinical and supported by histology. Our aim was to evaluate the outcomes of children undergoing circumcision for BXO and explore the correlation between surgical and histological findings.
MATERIALS AND METHODS
A 10-year retrospective review (2007-2017) of all children, aged 16 and less, undergoing circumcision at a tertiary teaching hospital was conducted. Statistical analysis was performed using Fisher's exact test.
RESULTS
BXO occurred in 91/1025 (8.9%) children. The highest incidence of BXO was in the 5 to 10 age group (13.3%; < 0.0001). The commonest symptom was foreskin scarring (62.6%). Intraoperatively, involvement of foreskin alone was seen in 26.4%, foreskin and meatus in 47.2%, and foreskin, meatus, and glans in 26.4%. Preoperatively, 24.2% of patients were prescribed steroid cream. Histologically, all patients showed microscopic changes confirming BXO. A total of 87.9% of patients only had a circumcision, and 11% required a meatal procedure along with the circumcision. Postoperatively, 19.8% of patients required a further procedure after an average duration of 5.8 months (range: 2-12 months); the majority of whom (83.3%) were prescribed postoperative steroid cream.
CONCLUSION
Clinical correlation by surgeons has a high degree of accuracy (>90%). Meatal involvement is more common than previously reported. The use of pre- or postoperative steroids does not obviate the need for further surgical procedures. Patients can have recurrent symptoms 1 year following surgery, and prolonged follow-up is necessary.
Topics: Adolescent; Balanitis Xerotica Obliterans; Child; Child, Preschool; Circumcision, Male; Follow-Up Studies; Humans; Incidence; London; Male; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 30130825
DOI: 10.1055/s-0038-1668562