-
Cureus Feb 2024Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed... (Review)
Review
Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed PRISMA-compliant keyword searches of PubMed, EMBASE, SCOPUS, LexisNexis, and other databases and identified 61 articles that met the inclusion criteria. In the bibliographies of these articles, we identified 58 more relevant articles and 28 internet items. We found high-quality evidence that NMC is a low-risk procedure that provides immediate and lifetime medical and health benefits and only rarely leads to later adverse effects on sexual function or pleasure. Given this evidence, we conclude that discouraging or denying NMC is unethical from the perspective of the United Nations Convention on the Rights of the Child, which emphasizes the right to health. Further, case law supports the legality of NMC. We found, conversely, that the ethical arguments against NMC rely on distortions of the medical evidence. Thus, NMC, by experienced operators using available safety precautions, appears to be both legal and ethical. Consistent with this conclusion, all of the evidence-based pediatric policies that we reviewed describe NMC as low-risk and beneficial to public health. We calculated that a reduction in NMC in the United States from 80% to 10% would substantially increase the cases of adverse medical conditions. The present findings thus support the evidence-based NMC policy statements and are inconsistent with the non-evidence-based policies that discourage NMC. On balance, the arguments and evidence reviewed here indicate that NMC is a medically beneficial and ethical public health intervention early in life because it reduces suffering, deaths, cases, and costs of treating adverse medical conditions throughout the lifetimes of circumcised individuals.
PubMed: 38405642
DOI: 10.7759/cureus.54772 -
Indian Journal of Dermatology 2022Ozone is a strong oxidizing agent, capable of promoting therapeutic effects such as antimicrobial, anti inflammatory, antioxidant and healing activities, with low... (Review)
Review
Ozone is a strong oxidizing agent, capable of promoting therapeutic effects such as antimicrobial, anti inflammatory, antioxidant and healing activities, with low probability of toxicity when used in a specific dosage range. The aim of this study was to conduct a literature review to assess clinical trials available over the past 10 years regarding the effectiveness and safety of ozone therapy to treat dermatological disorders. The search for bibliographic material was carried out through PubMed, Cochrane Library and Google Scholar electronic databases. The inclusion criteria covered only controlled clinical trials published from 2011 to 2021 and written in English. The 18 selected clinical trials included 1279 patients (ranging from 12 to 400 patients per study), of which 1185 patients were adults and 94 were children. Ozone therapy was evaluated regarding the treatment of diabetic foot ulcers, digital ulcers, chronic venous leg ulcers, atopic dermatitis, skin burns, onychomycosis, tinea pedis, cutaneous leishmaniasis, balanitis xerotica obliterans and multiple common warts. Only three studies, addressing the treatment of cutaneous leishmaniasis, skin ulcers and skin burns, evidenced lack of effectiveness of ozone treatment. Mild adverse effects occurred in three clinical trials, whereas severe side effects occurred in only one clinical trial, regarding skin ulcers. Therefore, ozone therapy may be suggested as an alternative or complementary treatment in some types of dermatological conditions specially affecting refractory patients. Though, a greater number of high-quality clinical trials is needed to clearly establish the safety of ozone therapy in dermatological disorders.
PubMed: 36578725
DOI: 10.4103/ijd.ijd_152_22 -
Urology Annals 2015Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This...
PURPOSE
Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This study has been carried out to present our experience about this disease with simultaneous review of the available literature.
MATERIALS AND METHODS
This retrospective study has been done at a tertiary care center of eastern India. The data of 306 patients affected with LS were analyzed for clinical presentation, physical examination, investigations, and treatment offered.
RESULTS
Presenting symptoms were non-specific. The prepuce was most commonly involved location followed by glans and meatus. Urethral involvement was not isolated as the primary site. Circumcision was done in 237 patients, while 63 patients underwent meatotomy. Thirty-six of 39 cases of LS induced stricture were treated with buccal mucosal graft (BMG) either in one stage or in two stages.
CONCLUSION
LS varies from being a highly aggressive disease of the penis and anterior urethra to a burnt out condition affecting just the meatus and surrounding glans. Early diagnosis and treatment are required to prevent its complication and associated morbidity. Management depends on the anatomical location of lesion, extent of involvement, rapidity of progression and its severity. Use of BMG in LS induced urethral stricture has shown encouraging results.
PubMed: 26229314
DOI: 10.4103/0974-7796.150490 -
Cureus May 2024A 57-year-old African-American male presented with urinary retention secondary to a history of balanitis xerotica obliterans (BXO) concurrent with penile carcinoma....
A 57-year-old African-American male presented with urinary retention secondary to a history of balanitis xerotica obliterans (BXO) concurrent with penile carcinoma. BXO, characterized by chronic, sclerosing inflammation of the male external genitalia, presents significant clinical challenges due to its progressive nature and potential for complications. The patient experienced recurrent episodes of urinary retention, leading to multiple hospital visits and disease progression, prompting a comprehensive evaluation and intervention. The patient's medical history revealed a complex array of comorbidities, including penile carcinoma secondary to BXO, urethral strictures, and meatal stenosis. Clinical assessment, including bedside bladder ultrasound and laboratory investigations, confirmed urinary retention secondary to urethral stricture, necessitating urological consultation. Management strategies involved Foley catheter placement, urethral dilation, and pharmacological interventions for pain management. Subsequent follow-up and imaging evaluations identified an increased risk of carcinoma development, highlighting the importance of surveillance and early intervention in patients with BXO. This case report highlights the intricate clinical manifestations and therapeutic considerations encountered in managing BXO and its associated pathologies.
PubMed: 38832208
DOI: 10.7759/cureus.59555 -
International Journal of Surgical... Aug 2020Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a...
Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a detailed histopathological description of penile LS, as well as to explore its relationship with penile intraepithelial neoplasia (PeIN) or invasive carcinoma. We evaluated 200 patients and designed a topographical approach for the histological evaluation focusing in alterations of the following anatomical layers: squamous epithelium, lamina propria, dartos, and corpus spongiosum. We documented the quantity and topographical location of stromal lymphocytes. The prevalent lesions found were epithelial hyperplasia, atrophy, PeIN, basal cell vacuolization, lamina propria sclerosis, and variable patterns of lymphocytic infiltration. Various unique patterns of stromal sclerosis were described: perivascular, globular, linear, and solid fibrosis/hyalinization; any of them were found to be diagnostic for LS. The variation in the topography and density of lymphocytes was determinant for the identification of LS morphological variants: lichenoid, band-like, lymphocytic depleted, and mixed. A major finding was the identification of the variant designated as lymphocytic depleted LS, which we considered as the morphological prototype of LS associated with penile neoplasia. The detailed description of this complex lesion presented in this study may help pathologists in practice to identify and better define LS. The identification of the special variants suggests a role of the stromal lymphocytes in the process of carcinogenesis. Confirmation of the observations with more studies is necessary to determine the significance of these findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Balanitis Xerotica Obliterans; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Penile Neoplasms; Precancerous Conditions; Young Adult
PubMed: 31969038
DOI: 10.1177/1066896920901333 -
British Journal of Urology Jun 1979Twenty patients with histologically proven balantis xerotica obliterans have undergone different forms of treatment; their progress has been reviewed and discussed....
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.
Topics: Adolescent; Adult; Aged; Balanitis; Circumcision, Male; Dilatation; Follow-Up Studies; Humans; Male; Middle Aged; Penis; Urethra; Urethral Stricture
PubMed: 465992
DOI: 10.1111/j.1464-410x.1979.tb02873.x -
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 -
Journal of Pediatric Urology Feb 2014Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in... (Review)
Review
OBJECTIVE
Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in different series; diagnosis is mostly clinical but histopathological confirmation is mandatory. Various treatments are described, but there is no consensus that one is the best.
MATERIALS AND METHODS
A literature review was made of BXO and lichen sclerosis in boys under 18 years of age, between 1995 and 2013, analyzing demographic dates, treatments and outcomes. In addition to that, we reviewed BXO cases treated in our centers in the last 10 years.
RESULTS
After literature review, only 13 articles matched the inclusion criteria. Analyzing those selected, the global incidence of BXO is nearly 35% among circumcised children. Described symptoms are diverse and the low index of clinical suspicion is highlighted. The main treatment is circumcision, with use of topical and intralesional steroids and immunosuppressive agents.
CONCLUSION
BXO is a condition more common than we believe and we must be vigilant to find greater number of diagnoses to avoid future complications. The main treatment for BXO is circumcision, but as topical or intralesional treatments are now available with potentially good outcomes, they may be considered as coadjuvants.
Topics: Adolescent; Adrenal Cortex Hormones; Balanitis Xerotica Obliterans; Child; Child, Preschool; Circumcision, Male; Combined Modality Therapy; Epidermis; Humans; Infant; Infant, Newborn; Male; Retrospective Studies
PubMed: 24295833
DOI: 10.1016/j.jpurol.2013.09.027 -
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 -
The Journal of Sexual Medicine Apr 2011Lichen sclerosus (LS) of the glans penis is a chronic, progressive, scleroatrophic inflammatory process of unknown etiology affecting the glans penis, prepuce, and... (Review)
Review
INTRODUCTION
Lichen sclerosus (LS) of the glans penis is a chronic, progressive, scleroatrophic inflammatory process of unknown etiology affecting the glans penis, prepuce, and urethra and may lead to severe impairment of sexual and urinary function.
AIMS
To report our experience of surgical management of LS of the glans penis.
MAIN OUTCOME MEASURES
Complications, patients' satisfaction, cosmesis, resolution of pain and puritus, and postoperative sexual function and were recorded retrospectively.
METHODS
The surgical outcome of the 31 patients who have undergone resurfacing of the glans penis with the use of skin grafting for the management of genital LS in our institute is reported.
RESULTS
After a median follow-up of 12.8 months, 26 patients (84%) were fully satisfied with cosmetic and functional results, and 71% of them have resumed sexual activity.
CONCLUSIONS
Resurfacing of the glans penis represents a simple and reproducible technique for the management of LS and yields excellent functional and cosmetic results.
Topics: Adult; Aged; Balanitis Xerotica Obliterans; Chronic Disease; Disease Progression; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Satisfaction; Penis; Phimosis; Quality of Life; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 21210959
DOI: 10.1111/j.1743-6109.2010.02165.x