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PubMed1996

T-cell predominant balanitis in a traumatic tetraplegic patient: a case report.

T-cell predominant balanitis is described in a 38 year old uncircumcised tetraplegic man whose presenting feature was non-progressive red lesions over the inner prepuce and the glans penis without signs of infection, phimosis, or meatal stenosis. There was no regional lymphadenopathy. He was not exposed to any of the high risk factors for human immunodeficiency virus infection. As the lesion did not respond to topical antibacterial, antifungal, and corticosteroid medications applied in that order, circumcision was performed. Following circumcision, the remaining lesion over the glans penis regressed completely over a period of 1 month. Histopathology of the excised prepuce revealed that both areas of normal nonkeratinizing squamous epithelium as well as areas with hyperplasia. No atypia was noted and Bowenoid changes were not seen. Immunohistochemical studies on the inflammatory infiltrate in the excised prepucial lesion using tissue proliferation markers (PCNA and MIB-1) revealed active proliferation of the band-like infiltrate shown by immunophenotyping (anti-human T cell, CD45RO, clone UCHL1 and L26, pan-B marker) to consist predominantly of T-cells, further supporting the hypothesis of a local immune-mediated inflammatory process as the final pathogenic mechanism of the penile lesion.

Adult↗
PubMed2000

Verrucous carcinoma arising in pseudoepitheliomatous keratotic and micaceous balanitis, without evidence of human papillomavirus.

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a condition which occurs on the glans penis of older men and may be associated with the development of a verrucous carcinoma. A role for human papillomavirus (HPV) in the aetiology of verrucous carcinoma has been implicated and several different HPV types have been found. We report a 74-year-old man who developed a verrucous carcinoma within an area of PKMB on the glans penis. Using a broad-spectrum polymerase chain reaction technique for identifying HPV, the epidermis of the area of PKMB and of the verrucous carcinoma were examined and no HPV DNA was identifiable. These results suggest that there is no part for HPV in the pathogenesis of PKMB or its transformation to verrucous carcinoma.

Aged↗
PubMed1998

Urethroplasty for balanitis xerotica obliterans.

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.

Balanitis↗
PubMed1999

Balanitis xerotica obliterans complicating hypospadias repair.

We review the literature and report a series of eight cases of balanitis xerotica obliterans (BXO) developing in patients following primary hypospadias repair. The ages of these patients ranged from 8 to 25 years with BXO developing from 1 to 16 years postoperatively. Six patients were treated by excision of the BXO tissue and two-stage urethroplasties with full-thickness grafts. Three of these patients had further recurrence of BXO and had re-do urethroplasty using a combination of bladder and buccal mucosa. The last two patients in this series had re-do urethroplasty using bladder mucosa only and bladder-buccal mucosa technique, respectively, as first choice for BXO complicating their hypospadias repair.

Adolescent↗
PubMed1984

Surgical treatment of balanitis xerotica obliterans.

Balanitis xerotica obliterans, or kraurosis penis, is a chronic progressive scleroatrophic process of the penis, prepuce, and urethral meatus. This syndrome is due to lichen sclerosus et atrophicus of the genital region. We have observed 32 patients, whose ages ranged from 24 to 78, with different clinical and pathologic findings. Clinical symptomatology consisted of painful erection with secondary impotence, burning, itching, and urinary disorders. The treatment in the early stages is pharmacologic; stenosis of the meatus, phimosis, scar adhesions, fissures, and erosions of glans and prepuce prescribe a surgical treatment. We have performed modified circumcision, meatotomy and meatoplasty, removal of the scleroatrophic tract and subsequent grafting. The functional results were satisfactory.

Adult↗
PubMedDate not supplied

Balanitis caused by group B beta-hemolytic streptococci.

A case of acute balanitis in an adult is described. Group B beta-hemolytic streptococci type 3 were recovered from an aspirate of the infected area and from the cervical canal of the patient's sexual consort. The patient and his consort were treated with oral ampicillin for ten days. After therapy the patient's infection cleared, and group B beta-hemolytic streptococci were not recovered from his consort. This case illustrates another aspect of disease due to group B beta-hemolytic streptococci in adults.

Adult↗
PubMed1985

Invasive candidal balanitis due to a condom catheter in a neutropenic patient.

A 58-year-old man with acute leukemia had balanitis and penile ulceration due to Candida tropicalis after a condom catheter was used because of urinary incontinence. This case illustrates that condom catheters can be associated with serious complications in neutropenic patients and should be used only when absolutely necessary.

Agranulocytosis↗
PubMed2003

Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system.

BACKGROUND: We analyzed the incidence of balanitis xerotica obliterans (BXO) by both age and ethnicity at an equal-access health care facility. METHODS: We retrospectively reviewed discharge records from 1997 to 1999 at Brooke Army Medical Center to determine ethnicity and age of patients with BXO. RESULTS: Of 153,432 male patients, 108 (0.070%) had a diagnosis of BXO. The age distribution was similar over a range from 2 to 90 years, with the exception of the third decade, when the incidence almost doubled. Black and Hispanic patients had twice the incidence found in white patients (10.59, 10.67 and 5.07 per 10,000 patients, respectively). CONCLUSION: At our equal-access health care facility, the incidence of BXO in black and Hispanic patients was double that in whites. This unexpected finding, in concert with the greater incidence in the third decade, may result from greater access to medical attention for these patients in the military setting. Nevertheless, further research into the origin of the disease is warranted.

Adolescent↗
PubMed2005

Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques.

PURPOSE: Balanitis xerotica obliterans (BXO) related strictures are complex and generally managed by 2-staged urethroplasty. We present our results with 1-stage dorsal onlay and 2-stage buccal mucosal urethroplasty for such strictures. MATERIALS AND METHODS: Between January 2000 and April 2004, 39 patients underwent buccal mucosal urethroplasty for BXO related anterior urethral strictures. The 25 patients with a salvageable urethral plate (group 1) were treated with 1-stage dorsal onlay urethroplasty using a cosmetic incision. The 14 patients with a severely scarred urethral plate, focally dense segments or active infection (group 2) underwent 2-stage urethroplasty. Outcomes in terms of cosmetic appearance, stricture recurrence and complications in the 2 groups were assessed. RESULTS: At a mean followup of 32.5 months (range 3 to 52) 3 patients (12%) in group 1 had recurrent stricture, of which 2 and 1 were treated with optical urethrotomy and urethral dilation, respectively. All patients had a normal slit-like meatus and none had chordee or erectile dysfunction. Four group 2 patients (28.6%) required stomal revision and 2 had glans cleft narrowing after stage 1 urethroplasty. Following stage 2, 3 patients had recurrent stricture, of whom 2 were treated with optical urethrotomy and 1 underwent repeat urethroplasty. CONCLUSIONS: In BXO related strictures with a viable urethral plate 1-stage dorsal onlay buccal mucosal urethroplasty provides excellent intermediate term results. The cosmetic incision described provides a normal, wide caliber, slit-like glans. Two-stage procedures provide satisfactory outcomes but they are associated with a higher revision rate.

Adolescent↗
PubMed1987

Micaceous and keratotic pseudoepitheliomatous balanitis and rapidly fatal fibrosarcoma of the penis occurring in the same patient.

A 55-year-old man had a rare, benign condition of the penis, micaceous and keratotic pseudoepitheliomatous balanitis, for 9 years before developing an aggressive soft tissue sarcoma of the glans. Five months after the appearance of this tumour, the patient died with widespread metastases. The sarcoma was small and superficial and the limited recorded experience suggested that local excision should offer a good prognosis. However, the histology showed poor differentiation and it would seem that this may be the important factor in the management and prognosis of penile sarcoma, as it is in sarcoma at other sites.

Balanitis↗
PubMed1989

Balanitis.

The clinical features of 100 cases of balanitis are described. The condition affects no more than 4% of boys, is commonest during pre-school years (but rare prior to toilet training) and is usually associated with a prepuce which is partly or completely non-retractable. It does not cause phimosis and no single pathogen is involved. Most boys suffer a single episode and circumcision is indicated only for those with recurrent, troublesome attacks.

Adolescent↗
PubMed2006

Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?

OBJECTIVE: To determine the incidence of balanitis xerotica obliterans (BXO) in a consecutive series of penile carcinomas in one centre, as BXO is a common penile disease that usually involves the prepuce and glans, and there have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship. PATIENTS AND METHODS: The reported incidence of penile carcinoma in patients with BXO is 2.6-5.8%, leading some to advocate circumcision in all cases, with close follow-up in those with persistent glanular disease. We prospectively analysed all cases of penile cancer referred to the unit over a 54-month period, to determine the prevalence of BXO. RESULTS: In all, 155 patients with penile malignancy were reviewed, 44 of whom had BXO (28%). This group included 34 men with squamous cell carcinoma and 10 with carcinoma in situ; in 39, BXO and malignancy presented synchronously. In three other cases, cancer occurred in the background of chronic persistent BXO; in two cases penile cancer was truly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and the patients presented when younger, but this was not statistically significant. CONCLUSION: A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. We think that patients presenting with long-standing BXO and those in whom BXO has not resolved after circumcision warrant biopsies and a careful follow-up.

Adult↗
PubMed1979

Necrotising balanitis due to a generalised primary infection with herpes simplex virus type 2.

Virological studies have proved herpes simplex virus type 2 to be the cause of the severe primary infection in a 37-year-old man with necrotising balanitis. Symptoms of urethritis preceded the appearance of a severe local lesion; dissemination of infection occurred and lesions developed on the skin of the scalp, neck, trunk, buttocks, arms, legs, and feet. No evidence of involvement of the central nervous system was found, and the penile and skin lesions improved rapidly after the application of 5% idoxuridine in dimethylsulphoxide. Recurrences occurred at various skin sites at six to seven months after the primary infection.

Adult↗
PubMed1991

Squamous carcinoma of the penis and previous recurrent balanitis: a case report.

A 33 year old uncircumcised Caucasian male who had a 7 year history of intermittent erosive balanitis and herpes, presented with an 18 month history of progressively worsening penile ulceration not responding to the usual medication. Biopsy of the glans penis carried out in view of the long standing ulceration showed a sqamous cell carcinoma of the penis. As there was no response to radiotherapy, partial penectomy was carried out. The importance of early biopsy is emphasised when ulcerative lesions of the penis do not respond adequately to medical therapy. Different treatment modalities available are reviewed.

Adult↗
PubMed1995

Detection of human papillomavirus types in balanitis xerotica obliterans and other penile conditions.

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.

Balanitis↗
PubMed2004

Review of 120 biopsies performed on the balanopreputial sac. from zoon's balanitis to the concept of a wider spectrum of inflammatory non-cicatricial balanoposthitis.

BACKGROUND: Long-lasting erythematous lesions involving the balanopreputial sac may be clinically difficult to classify, and biopsies may be performed in order to clarify the nature of the disease. However, our previous experience led us to consider several cases as histopathologically unclassifiable. OBJECTIVE: To establish the causes of such unsatisfactory findings. METHODS: We reviewed 120 balanopreputial sac biopsies performed at the surgical unit of our institute from January 1999 to December 2002 examining also the patients' clinical records. RESULTS: We found that a small group of previously unclassified cases showed common clinical and histopathological features. Clinically, all patients were uncircumcised and had long-lasting asymptomatic erythematous plaques on the balanopreputial sac with no erythroplastic or lichenoid features and no correlation with sexual intercourse. Histologically, all specimens showed a thinned and spongiotic epithelium, a band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation. CONCLUSIONS: In our view, these cases fall within a spectrum of inflammatory non-cicatricial disorders, ranging from almost pure lymphohistiocytic forms to forms which fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon. We propose to classify these cases histologically as inflammatory non-cicatricial balanoposthitis and clinically as idiopathic inflammatory non-cicatricial balanoposthitis.

Adult↗