[BALANIC HYPOSPADIAS: WHY, WHEN AND HOW TO OPERATE].
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Description of three apocrine cystadenomas: two of the face and scalp and one of the glans (urethral meatus and left anterior surface of the navicular fossa) with no bibliographical precedent. From a clinico-histological standpoint the importance of objective data which make possible the clinical diagnosis is stressed allowing light microscope differentiation from eccrine hydrocystoma. The histogenesis is exposed and it appears convenient to name (eccrine or apocrine) cystadenoma the authentic cystic adenoma (among the organoid hamartoma of the cutaneous appendages, while reserving the term (eccrine or apocrine) hydrocystoma for glandular cysts. Due to the esthetic and occasionally functional repercussion, surgical excision is indicated.
OBJECTIVES: To determine the penile, perianal, and oropharyngeal candidal colonisation rates among homosexual and heterosexual males attending an STD clinic. To determine the prevalence of balanitis and candidal balanitis in the two groups. SUBJECTS: 252 heterosexual and 210 homosexual male patients attending consecutively the STD clinic in Coventry, England. DESIGN: A prospective study recording sexual behaviour, relevant history, symptoms, and examination. Specimens for candida culture were collected from the glans penis, perianal area, and oropharynx. RESULTS: Among the 462 men studied, penile, perianal, and oropharyngeal colonisation rates were 74 (16%), 70 (15%), and 116 (25%) respectively. On examination, 47 (10%) were found to have balanitis. Of the 74 patients with penile colonisation, 26 (37%) were symptomatic and 20 (27%) had balanitis. The 223 heterosexual and the 196 homosexual males who had sexual intercourse within 3 months had comparable colonisation rates of candida on the penis, perianal area, and oropharynx. Balanitis was seen in 31 heterosexuals (14%) and candidal balanitis in 16 (7%); the incidence was significantly less in homosexuals where balanitis was seen in 12 (6%) and candidal balanitis in four (2%). CONCLUSIONS: Itching or burning sensations after sex were the most common symptoms associated with penile colonisation with candida and were present in more than one third. Candidal balanitis was commoner in those who had vaginal than those who had anal intercourse within 3 months.
During the years 1985 up to 1995 53 patients between 18 and 80 years of age (mean age 54.7 years) with histologically and clinically proven Zoon's balanitis were treated by circumcision. The majority of patients had symptoms for more than 12 months. In five cases they had lasted for 8, 10, 16, 17 and 47 (!) years. 30 patients were investigated by means of physical examination and questionnaire in this retrospective study. Lesions involved glans in all patients, while in 17 of 30 patients both glans and prepuce were involved. None of the patients showed lesions of the prepuce only. In most cases Zoon's balanitis was successfully treated by circumcision in a period of two to four weeks. In four cases, psoriatic lesions, and in one case lichen ruber was diagnosed. In the remaining patient, whose circumcision was inadequate, a small area of balanitis persisted in the sulcus coronarius still covered by the foreskin. The curative effect of adequate circumcision in 100% of patients suggests that Zoon's balanitis is a relatively non-specific reactive balanitis caused by a disturbed "preputial-ecology". It is remarkable that other distinct inflammatory diseases of glans and prepuce can show features which are identical to those Zoon's balanitis.
OBJECTIVE: To document prospectively variation in penile morphology and clinical findings in children. PATIENTS AND METHODS: The study comprised a consecutive sample of 468 boys whose consultation with a physician included a genital examination in a primary-care paediatric practice in rural northern Wisconsin. RESULTS: Circumcised boys under 3 years of age were significantly more likely to have a partially or completely covered glans, a reddened meatus, balanitis, or trapped epithelial debris, and less likely to have a fully exposed glans than were circumcised boys of 3 years or older. Among the 238 boys under 3 years, those circumcised were significantly more likely to have non-cosmetic problems, including coronal adhesions, trapped epithelial debris, a reddened meatus, preputial stenosis (phimosis) and balanitis, than were boys with a foreskin. Findings in the circumcised group under 3 years included: fully exposed glans (n = 78, 35.6%), partially covered glans (n = 67, 30.6%), adhesions (25.6%), completely covered glans (20.1%), entrapped desquamated epithelial debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and preputial stenosis (0.9%). Only two genital examinations in boys with foreskins revealed pertinent findings. Coronal adhesions develop in circumcised boys at 2-6 months of age and usually resolve by 24 months. The degree of skin covering the glans after neonatal circumcision peaks at 6 months of age. CONCLUSIONS: There are significant variations of appearance in circumcised boys; clinical findings are much more common in these boys than previously reported in retrospective studies. The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) affects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds.
Genital diseases include a wide range of lesions e.g. infectious and inflammatory. In most cases a clinical diagnosis is reached without the need for a biopsy. Nonetheless, a genital biopsy is safe and may help to confirm the diagnosis. We established a dedicated diagnostic biopsy clinic in 2003. Our objective was to evaluate the effectiveness of our diagnostic biopsy clinic and compare it with other Genitourinary medicine (GUM) clinics in the UK. A retrospective case-note study was performed on 71 patients referred to the biopsy clinic with persistent genital lesions over a 12-month period. Forty-seven biopsies were performed (71% biopsy rate). 43 specimens (92%) were appropriate for histopathological diagnosis. Of these 15% were lichen planus, 15% lichen sclerosis, 10% psoriasis, 7.5% each: eczema, Zoon's and non-specific balanitis. The remainder represented a variety of other conditions. In 27 cases (68%) the clinical diagnosis was consistent with the histological result. The possibility of self-referral and walk-in nature of our GUM service substantially decrease the waiting times for assessment of anogenital disorders. We had a lower biopsy rate for the diagnosis of non-specific balanitis (7.5%) compared with the average rate (21.5%) in 14 UK GUM clinics and good agreement between clinical and histological diagnosis. An empirical first treatment, with simple emollients before biopsy, appears to be a safe clinical approach for the treatment of non-specific balanitis. A multidisciplinary approach (GUM physicians, dermatologists and urologists/gynaecologists) could help prevent unnecessary biopsies and improve correlation between clinical and histological diagnosis.
AIMS: To determine the incidence of mucinous metaplasia occurring in the foreskin or glans penis and any associated clinical or histopathological features. METHODS AND RESULTS: Following the recognition of two index cases, 100 other foreskin specimens were retrieved from the histopathology archives at Southampton General Hospital. The haematoxylin and eosin-stained slides were examined by a single observer to detect the presence of mucin-producing cells in the surface epithelium. The absence of mucinous metaplasia in negative cases was confirmed with mucin histochemistry. In total, four cases of mucinous metaplasia were identified, three involving the foreskin and one involving the glans penis. The age range was 51-80 years. Three cases were associated with Zoon's balanitis and the fourth showed mild non-specific balanitis. All four cases showed positive staining with both diastase periodic acid-Schiff and alcian blue. No mucin-producing cells were identified in non-inflamed or minimally inflamed specimens. CONCLUSIONS: Mucinous metaplasia of the penis is an uncommon but under-recognized condition. It is seen in the elderly and appears to be a metaplastic change associated with severe chronic inflammation, and possibly more specifically with Zoon's balanitis. Our study identified a case affecting the glans penis, a site not previously recorded.
Our entire clinical experience with the use of carbon dioxide (CO2) laser in the treatment of 67 patients with diverse external genital lesions is presented. Successful eradication was accomplished in 61 patients with wide distribution of condylomatous lesions, with 88 per cent responding to a single laser treatment. Excellent cosmetic results, as well as complete disappearance of balanitis xerotica obliterans and erythroplasia of Queyrat, were observed in 5 additional patients. Laser therapy, although not an established treatment option, appears to be a safe alternative and should be considered in those patients with recurrent genital condylomata, balanitis xerotica obliterans, as well as erythroplasia of Queyrat, not responding to well-known treatment modalities.
Two cases of squamous cell carcinoma of the prepuce arising on balanitis xerotica obliterans are described. This event is unusual and not well known. The surgical treatment was a wide circumcision in which the prepuce and part of the shaft skin were removed, performing as well a decortication of the glans base. This technique seemed to be satisfactory in removing the carcinoma and obtaining a definite improvement in the clinical picture of balanitis xerotica obliterans as well.
A retrospective study was carried out to determine whether penile cancer, like cervical cancer, was associated with smoking and sexual behaviour. Altogether 244 men with penile cancer and 232 matched controls completed a questionnaire by post or telephone. Data on marital state, socioeconomic group, occupation, history of phimosis and balanitis, sexual behaviour, and smoking were obtained. The results of statistical analyses confirmed that phimosis and balanitis were risk factors for penile cancer, but there was no epidemiological evidence for it being a sexually transmitted disease. Smoking was a risk factor with a dose-response relation and remained associated with penile cancer even after adjustment for confounding factors. Penile cancer is associated with smoking independently of phimosis; treatment of phimosis alone does not remove the risk caused by smoking.