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Journal of Pediatric Urology Apr 2017We review outcomes after management of meatal balanitis xerotica obliterans (BXO). The primary outcome was recurrent meatal BXO.
INTRODUCTION
We review outcomes after management of meatal balanitis xerotica obliterans (BXO). The primary outcome was recurrent meatal BXO.
METHODS
A database comprising mostly hypospadias patients was queried for meatal BXO. The disease was confirmed histologically in all cases. Management included topical steroids and/or immunosuppressants, and/or surgical excision of BXO with two-stage oral mucosa graft circumferential replacement urethroplasty.
RESULTS
A total of 12 patients had meatal BXO (8 boys and 4 adults). Of these, 10 had hypospadias, two presenting without prior surgery and eight returning 5-30 years after one or multiple (n = 2) repairs. Another two boys did not have hypospadias: one developing BXO 10 years after newborn circumcision and the other having persistent meatal BXO following therapeutic circumcision. Topical and intraluminal steroids (1% betamethasone or clobetasol) and tacrolimus were used for ≥12 weeks each as primary therapy or for meatal recurrence in a total of six cases. Complete response with resolution of white discoloration and relief of stranguria only occurred in two of the three receiving clobetasol, with follow up ≤12 weeks. BXO excision and urethroplasty was done in 11 patients, 10 using oral mucosa grafts; one with a focal lesion and a negative frozen section had reoperative TIP. Of the 10 undergoing excision with two-stage replacement urethroplasty, six remain disease free at a mean follow-up of 23 months (8-48 months), and four had recurrent stranguria and visible meatal BXO at a median of 26 months (22-105 months). Three of the four with recurrences had additional treatment and one was lost to follow-up. All initially had topical steroids, and two also used tacrolimus, without clinical resolution. These three then underwent a second BXO excision and two-stage oral graft replacement urethroplasty. In two recurrences, BXO was found invading from the meatus proximally within oral mucosa (Figure). Of these three with secondary urethroplasties, two are free of disease at 6 and 18 months, and the third had another meatal recurrence 6 months after the second stage.
DISCUSSION
We found topical steroids and immunosuppressants to have limited efficacy, with two clinical complete responses achieved only with clobetasol in patients with short follow-up. Forty percent of patients recurred at 2-9 years after visually complete BXO excision and two-stage oral mucosa graft replacement urethroplasty, and in two cases disease invaded into oral mucosa, the first well-documented cases of this occurrence.
Topics: Adult; Age Factors; Balanitis Xerotica Obliterans; Child; Child, Preschool; Databases, Factual; Follow-Up Studies; Humans; Hypospadias; Infant, Newborn; Male; Mouth Mucosa; Plastic Surgery Procedures; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Steroids; Surgical Flaps; Treatment Outcome; Urologic Surgical Procedures, Male; Young Adult
PubMed: 28089110
DOI: 10.1016/j.jpurol.2016.10.014 -
Zhonghua Nan Ke Xue = National Journal... Jul 2014Male genital lichen sclerosus (MGLSc) is a chronically relapsing disease characterized by a long course, gradual aggravation, and a tendency towards malignancy. Once... (Review)
Review
Male genital lichen sclerosus (MGLSc) is a chronically relapsing disease characterized by a long course, gradual aggravation, and a tendency towards malignancy. Once called balanitis xerotica obliterans, MGLSc has a distinct predilection for the prepuce and glans, involving the urethra when aggravating, forming scarring tissues, and causing urethral stricture, which may seriously affect the patients'quality of life with such symptoms as urinary stream narrowing, dysuria, and painful penile erection. The etiology and pathogenesis of MGLSc have not yet been adequately explained though it is generally thought to be associated with autoimmune mechanism, genetic factors, infections, local trauma, and chronic urinary irritation. MGLSc can be fairly easily diagnosed according to its clinical manifestations and histopathological results, but can be hardly cured. Early diagnosis and prompt treatment are the most important approaches, which may relieve its symptoms, check its progression, and prevent its long-term sequelae. Ultrapotent topical corticosteroids are the choice for the treatment of MGLSc. For those who fail to respond to expectant medication or have dysuria due to urethral stricture and painful erection, rational surgery may be resorted to, with importance attached to long-term follow-up. This article presents an update of the diagnosis and treatment of MGLSc and MGLSc-induced urethral stricture.
Topics: Genital Diseases, Male; Humans; Lichen Sclerosus et Atrophicus; Male; Urethral Stricture
PubMed: 25095613
DOI: No ID Found -
Urology Sep 2004Strictures due to lichen sclerosus (LS) may affect the urethra as far proximally as the mid-bulb. For such strictures, a staged full-length repair is required and should... (Review)
Review
OBJECTIVES
Strictures due to lichen sclerosus (LS) may affect the urethra as far proximally as the mid-bulb. For such strictures, a staged full-length repair is required and should use a nonpenile graft source such as buccal mucosa. Many cases occur in a population already accustomed to seated voiding, leading us to re-evaluate this approach and, in some circumstances, recommend definitive perineal urethrostomy alone.
METHODS
We reviewed the medical records and retrograde urethrograms of all patients undergoing surgery for LS at our facilities between January 1991 and June 2002.
RESULTS
A total of 63 patients, with an average age of 54.2 years, underwent surgery for LS stricture with an average follow-up of 38.5 months (range 4 to 117). Of the 63 patients, 19 underwent grafting in preparation for future reconstruction. Of these, 11 completed the second-stage repair, and 8 patients elected not to undergo the second stage of the repair, leaving a functional perineal urethrostomy. This led us to look more critically at definitive perineal urethrostomy alone for some patients. Parallel with the staged repairs, and subsequent to them, 44 patients underwent perineal urethrostomy alone.
CONCLUSIONS
The often extensive nature of LS, the prevailing philosophy that urethroplasty must use nonpenile skin, the limited availability of such sources, and the acceptance of many patients for seated voiding makes definitive perineal urethrostomy alone a viable treatment option. In all our cases, this satisfied patients' quality of life concerns, leaving the anterior urethra dry and amenable to future repair. Younger men desirous of penile voiding should still be considered for staged repair using current techniques.
Topics: Adult; Aged; Balanitis; Follow-Up Studies; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Satisfaction; Perineum; Quality of Life; Plastic Surgery Procedures; Unnecessary Procedures; Urethral Stricture
PubMed: 15351594
DOI: 10.1016/j.urology.2004.04.035 -
Canadian Family Physician Medecin de... Oct 1994
Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Balanitis; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male
PubMed: 7950467
DOI: No ID Found -
British Journal of Urology May 1998To review the results of different methods of urethroplasty for anterior urethral strictures caused by balanitis xerotica obliterans (BXO).
OBJECTIVE
To review the results of different methods of urethroplasty for anterior urethral strictures caused by balanitis xerotica obliterans (BXO).
PATIENTS AND METHODS
Twenty-eight patients underwent urethroplasty for BXO; 12 had a one-stage pedicled penile skin-flap urethroplasty and 16 excision and a two-stage free-graft urethroplasty using nongenital skin.
RESULTS
The treatment failed in all patients undergoing a one-stage pedicle penile skin urethroplasty because the disease recurred with BXO, whereas the treatment failed in only one patient using a two-stage free graft procedure.
CONCLUSION
A two-stage free-graft urethroplasty using nongenital skin is recommended for anterior urethral strictures caused by BXO.
Topics: Balanitis; Follow-Up Studies; Humans; Male; Plastic Surgery Procedures; Recurrence; Reoperation; Surgical Flaps; Treatment Failure; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 9634051
DOI: 10.1046/j.1464-410x.1998.00634.x -
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 -
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 -
The Journal of Urology Sep 1995We study the prevalence of human papillomavirus deoxyribonucleic acid (DNA) in squamous cell carcinoma and control tissue of the penis. (Review)
Review
PURPOSE
We study the prevalence of human papillomavirus deoxyribonucleic acid (DNA) in squamous cell carcinoma and control tissue of the penis.
MATERIALS AND METHODS
The technique of polymerase chain reaction DNA amplification was used to detect specific human papillomavirus DNA sequences in archival pathological and control tissues. We analyzed 42 cases of invasive squamous cell carcinoma, 13 of carcinoma in situ, 12 of penile intraepithelial neoplasia, 3 of verrucous carcinoma and 25 of balanitis xerotica obliterans, as well as 29 routine neonatal circumcision specimens and 32 adult circumcision specimens.
RESULTS
Overall, the detection rates for human papillomavirus DNA in the study and control tissues were 55% (23 of 42 cases) for invasive squamous cell carcinoma, 92% (12 of 13) for carcinoma in situ, 92% (11 of 12) for penile intraepithelial neoplasia, 0% (0 of 3) for verrucous carcinoma, 4% (1 of 25) for balanitis xerotica obliterans, 0% (0 of 29) for neonatal circumcision and 9% (3 of 32) for adult circumcision. In all groups human papillomavirus type 16 was the most common genotype identified.
CONCLUSIONS
The prevalence of human papillomavirus DNA is significantly greater in carcinoma of the penis than in control tissue. Moreover, the prevalence is greater in noninvasive lesions (carcinoma in situ and penile intraepithelial neoplasia) than in invasive carcinoma.
Topics: Balanitis; Base Sequence; Carcinoma in Situ; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Circumcision, Male; DNA, Viral; Humans; Infant, Newborn; Lymphatic Metastasis; Male; Molecular Sequence Data; Papillomaviridae; Penile Neoplasms
PubMed: 7637047
DOI: No ID Found -
BJU International Dec 2021To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis xerotica obliterans (BXO) and (ii) patient outcomes to inform future study design.
PATIENTS AND METHODS
Approval was obtained from the UK Health Research Authority and local Research Ethics Committee (Reference 16/NW/0364) and the trial protocol registered with ClinicalTrials.gov (NCT02854995). A total of 20 boys (aged 2-16 years) with BXO were randomised to either circumcision or PIT (online parallel group 1:1 allocation, non-blinded). Exclusion criteria were: (i) previous penile surgery and (ii) contraindication for either treatment. Follow-up (including satisfaction questionnaire) was at 6 weeks, 3 and 12 months. Data are presented as median (interquartile range [IQR]), continuous variables were compared by t-test.
RESULTS
A total of 54 boys were approached over 18 months: 23 (45%) were recruited and randomised. The commonest reason for non-entry was treatment preference: 12 preferred circumcision, 18 preferred PIT. Four patients withdrew after randomisation, three did not want circumcision and one did not want PIT. The groups were similar in terms of age (median [IQR] 11 [6-12] vs 8 [7-10] years, P = 0.53) and duration of symptoms (median [IQR] 6 [6-15] vs 6 [2-24] months, P = 0.77). There were no protocol breaches, serious adverse events or postoperative meatal stenosis. There was one self-resolving haematoma after PIT and one suture granuloma after circumcision. Two boys went on to have a circumcision after PIT. Overall, satisfaction levels were high for both groups.
CONCLUSION
A definitive RCT of circumcision vs PIT for BXO appears feasible, with 39% of those approached completing the trial. More families preferred PIT. A robust comparison in the form of a multicentred RCT is required.
Topics: Adolescent; Anti-Inflammatory Agents; Balanitis Xerotica Obliterans; Child; Child, Preschool; Circumcision, Male; Combined Modality Therapy; Feasibility Studies; Foreskin; Humans; Injections, Intralesional; Male; Patient Satisfaction; Plastic Surgery Procedures; Triamcinolone
PubMed: 34110689
DOI: 10.1111/bju.15508 -
Genitourinary Medicine Aug 1995To determine the prevalence of human papillomavirus (HPV) types 6, 11, 16 and 18 in foreskin biopsies from patients with balanitis xerotica obliterans (BXO) and other...
OBJECTIVES
To determine the prevalence of human papillomavirus (HPV) types 6, 11, 16 and 18 in foreskin biopsies from patients with balanitis xerotica obliterans (BXO) and other penile conditions.
MATERIALS AND METHODS
Foreskin biopsy specimens from 24 patients with penile lesions and 5 control patients were analysed by type-specific polymerase chain reaction (PCR).
RESULTS
HPV6 or HPV16 were not detected in patients with BXO. HPV6 was detected in 2 controls.
CONCLUSIONS
Genital papillomaviruses do not have a strong association with BXO.
Topics: Balanitis; Base Sequence; Humans; Male; Molecular Sequence Data; Papillomaviridae; Papillomavirus Infections; Polymerase Chain Reaction; Tumor Virus Infections
PubMed: 7590713
DOI: 10.1136/sti.71.4.228