Balanitis xerotica obliterans: surgical treatment

The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature

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.

Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients

BACKGROUND

Surgical options in male patients with genital lichen sclerosus (LS) involving the anterior urethra still represent a challenging issue.

OBJECTIVE

To review the outcome of surgical treatment in patients with genital and urethral LS.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter, international, retrospective, observational descriptive study performed in two specialized centers. Two hundred fifteen male patients underwent surgery for histologically proven genital LS involving the foreskin and/or the anterior urethra.

INTERVENTION

Circumcision (34 cases), meatotomy (15 cases), circumcision and meatotomy (8 cases), one-stage penile oral mucosal graft urethroplasty (8 cases), two-stage penile oral mucosal graft urethroplasty (15 cases), one-stage bulbar oral mucosal graft urethroplasty (88 cases), and definitive perineal urethrostomy (47 cases).

MEASUREMENTS

Primary outcome was considered a failure when any postoperative instrumentation was needed, including dilation, or when recurrence was diagnosed.

RESULTS AND LIMITATIONS

The average follow-up was 56 mo (range: 12-170 mo). Circumcision showed 100% success rate with no recurrence of the disease; meatotomy, 80% success rate; circumcision and meatotomy, 100% success rate; one-stage penile oral mucosal graft urethroplasty, 100% success rate; two-stage penile oral mucosal graft urethroplasty, 73% success rate; one-stage bulbar oral mucosal graft urethroplasty, 91% success rate; and definitive perineal urethrostomy, 72% success rate. Limitations include short follow-up for recording neoplastic degeneration and no instrument to investigate quality of life.

CONCLUSIONS

Patients with LS disease restricted to the foreskin and/or external urinary meatus showed a high surgery success rate. In patients with penile urethral strictures or panurethral strictures, the use of one-stage oral graft urethroplasty showed greater success than the staged procedures.

[Balanitis: diagnosis and treatment]

Balanitis refers to a variety of unrelated conditions. It results from infective, irritative, allergic, traumatic, or inflammatory causes; pre-malignant lesions have been also identified. All these causes are successively reviewed regarding their positive diagnosis and their treatment. Normal aspects of the balanopreputial area will be explained because they may cause some anxiety in certain patients. The difference between the circumcised and uncircumcised penile skin that cause differences in the incidence and appearance of dermatoses of the glans and corona will be studied. Pre-malignant lesions of the balanopreputial area, although not frequent, represent a difficult diagnosis and therapeutic challenge. The major problem is the earliness of the diagnosis that may avoid the occurrence of squamous cell carcinoma. Moreover, lichen sclerosus may develop into squamous cell carcinoma and therefore a lifelong follow-up must be implemented. Thus, any fixed, chronic or suspicious Lesion must be rapidly assessed by a biopsy.

Composition of the inflammatory infiltrate in pediatric penile lichen sclerosus et atrophicus (balanitis xerotica obliterans): a prospective, comparative immunophenotyping study

Dermatopathological evaluation of pediatric preputial inflammatory disease rarely allows for specific diagnosis other than pediatric penile lichen sclerosus et atrophicus (balanitis xerotica obliterans, LSA/BXO). A prospective immunopathological study was performed on 20 consecutive, unselected, clinically and histopathologically confirmed LSA/BXO cases to determine the relative presence of T and B lymphocytes. There were seven cases with early stages of disease, eight with florid disease, and five with later stages of disease. Two ritual circumcision specimens and 12 specimens with non-LSA/BXO balanitis, collected during the same period, were used as controls. The infiltrate in LSA/BXO patients was wholly composed of T cells (positive with UCLH-1 antibody) in all cases. B cells (positive with L-26 antibody) were found only focally in small, discreet, easily recognizable (follicular or early follicle-like) aggregates, positioned slightly deeper than the band-like infiltrate of T cells. T cells were inconspicuous in 9 of the 12 control specimens. In the three other controls, T cells were much more obvious and these patients showed clinical features possibly suggestive of LSA/BXO in early, prediagnosable phases of development. We conclude that limited immunophenotyping may be a useful adjunct to diagnosis in pediatric cases in which only limited tissue is available or the disease may be more difficult to classify with confidence.

Carbon dioxide laser treatment of lichen sclerosus et atrophicus

We followed 62 men treated with the carbon dioxide laser for lichen sclerosus et atrophicus for an average of 30 months (3 months to 7 years). Of the patients 47 (76%) became asymptomatic and 10 (16%) had minor residual symptoms. In 26 patients (40%) concomitant superficial meatal stenosis was simultaneously treated with laser meatotomy. The cosmetic and functional results of treatment were highly encouraging. Provided that radicality is achieved at the primary application, the carbon dioxide laser is an excellent therapeutic modality for lichen sclerosus et atrophicus.