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Zundel S, Ellerkamp V. Balanoposthitis in children: Analysis of treatment diversity and development of a treatment proposal. J Pediatr Urol 2024:S1477-5131(24)00097-4. [PMID: 38461077 DOI: 10.1016/j.jpurol.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Balanoposthitis in boys with physiological phimosis is common. Publications on the topic are rare and literature provides no evidence-based guidelines on treatment efficacy. With this study, we aim to analyze treatments currently used, physicians' experience regarding the success and thus derive a treatment proposal. STUDY DESIGN An online questionnaire was created to evaluate practice patterns and experience. A case scenario, open questions and multiple-choice questions were used to allow multilayered answers. Pediatricians, pediatric surgeons, pediatric urologists, and family practitioners were invited to participate. Demographic data and answers to multiple choice questions were analyzed descriptively. Free text comments were analyzed quantitively by coding the text entries and identifying relevant themes. The themes were then grouped into categories. RESULTS Three-hundred-and-one data sets were analyzed. Predominantly, participants were from Germany and Switzerland, and most were specialized in either pediatrics or pediatric surgery. The analysis revealed a wide variability of treatments. Three main treatment forms were identified: baths, topical antiseptic treatment (wraps, gels), and topical antibiotics. Many participants use combinations of the above. Altogether, 53 treatment varieties and 27 categories were identified, including oral antibiotics and local irrigation. Treatment success was reported to be good for all treatment forms, baths were reported to be the best perceived treatment by the majority of participants. DISCUSSION The online questionnaire generated valuable data on the wide variety of treatment used for posthitis. The fact that all treatments are reported to be highly effective suggests that little is necessary to treat the condition or that it might even be self-limiting. Further studies will be needed to prove this conclusion. Until those are available, three main concepts should be considered when choosing a treatment: avoid (traumatizing) manipulation, apply antibiotic stewardship and adhere to families' preferences and feasibility. CONCLUSION We propose baths or local antiseptics, depending on the practitioner's and family's choice as the least invasive alternative. A prospective study to back our recommendation is scheduled.
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Affiliation(s)
- Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland.
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2
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Bellinato F, Ioris T, Pascucci E, Viola F, Gisondi P, Girolomoni G. Long-term follow-up of Zoon balanitis: a retrospective cohort study. Arch Dermatol Res 2023; 316:44. [PMID: 38103087 DOI: 10.1007/s00403-023-02769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Tommaso Ioris
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Enrico Pascucci
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Federica Viola
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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3
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Hook S, Gross AJ, Becker M, Netsch C, Rosenbaum C, Becker B. [Skin manifestations of the external male genitals]. Urologie 2023:10.1007/s00120-023-02123-3. [PMID: 37314487 DOI: 10.1007/s00120-023-02123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
The urological examination includes the inspection of the external male genitals. Harmless normal variants, such as heterotopic sebaceous glands and pearly penile papules must be differentiated from malignant and infectious manifestations. Lichen sclerosus et atrophicus is a frequent connective tissue disease that can lead to functional impairments and an associated high level of suffering for those affected. Both conservative and invasive treatment options are available. Sexually transmitted diseases, such as syphilis, are gaining increasing importance in routine clinical and daily practice due to the increasing incidence in recent years. An early diagnosis and treatment of malignant neoplasms, such as Queyrat's erythroplasia can be carried out by routine inspection of the genital skin.
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Affiliation(s)
- S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - M Becker
- Abteilung für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
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Talapko J, Meštrović T, Škrlec I. Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review. World J Diabetes 2022; 13:809-821. [PMID: 36311997 PMCID: PMC9606786 DOI: 10.4239/wjd.v13.i10.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.
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Affiliation(s)
- Jasminka Talapko
- Laboratory for Microbiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University North, University Centre Varaždin, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation, Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Ivana Škrlec
- Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
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5
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Puri N, Singh O, Brar BK. Case report of co-existing keratotic balanitis and squamous cell carcinoma in a 42-year-old male. Indian J Sex Transm Dis AIDS 2022; 43:206-207. [PMID: 36743112 PMCID: PMC9891020 DOI: 10.4103/ijstd.ijstd_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
Although a number of premalignant and malignant lesions affect the genitalia of men, such as condyloma acuminata, erythroplasia of queyrat, squamous cell carcinoma, hyperkeratotic balanitis is rare and a patient showing both hyperkeratotic and well-differentaited squamous cell carcinoma is rarer. We report the case of a 42-year-old male, who had a hyperkeratotic plaque like lesions over the glans, with accompanied atrophic areas.
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Affiliation(s)
- Neerja Puri
- Department of Dermatology, G G S Medical College, Faridkot, Punjab, India
| | - Onkar Singh
- Department of Dermatology, G G S Medical College, Faridkot, Punjab, India
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6
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Blum AE, Tsiaras WG, Kemp JM. Hydroxyurea-induced genital ulcers and erosions: Two case reports. J Tissue Viability 2021; 30:462-4. [PMID: 34147315 DOI: 10.1016/j.jtv.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Hydroxyurea is a chemotherapeutic agent used for myeloproliferative disorders and sickle cell anemia that is well known to cause painful mucocutaneous ulcers, typically involving the legs or mouth. However, genital ulcerations due to hydroxyurea therapy are a rare, and likely underrecognized, adverse effect with only a few cases reported in the literature to date. Ulcers of the lower legs caused by hydroxyurea are associated with a diagnostic delay, and this is likely exacerbated in cases of genital ulceration due to a lack of awareness. Herein we present two cases of painful genital ulceration in patients on hydroxyurea therapy. In the first Case, an 87 year-old male with polycythemia vera developed an ulcer on the scrotum, which was assessed initially through virtual visits during the COVID-19 pandemic, and was refractory to topical and oral antibiotic treatments. The second case was a 79 year-old male with essential thrombocythemia and a history of persistent leg ulcers who developed erosions of the glans penis. Both patients experienced complete resolution within weeks of discontinuing hydroxyurea therapy. In conclusion, genital ulcers and erosions induced by hydroxyrea may be underrecognized in clinical practice, but if identified, withdrawal of hydroxyurea leads to quick resolution of these lesions and the associated pain.
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Abstract
Reproductive tract diseases can be a significant cause of subfertility or infertility in male small ruminants. Affected males can usually be identified early by performing routine serologic screening and yearly breeding soundness examinations. Early diagnosis will either maximize treatment success or expedite culling decisions. Once clinical signs of diseases develop, prognosis for breeding ability declines. Veterinary practitioners should used ancillary diagnostic techniques, such as ultrasound examination and laboratory testing to acquire a diagnosis and determine prognosis of reproductive lesions. Some diseases (eg, brucellosis) should be ruled out immediately to cull affected animals and minimize transmission within the herd.
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Affiliation(s)
- Jamie L Stewart
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, 205 Duckpond Drive, Blacksburg, VA 24061, USA.
| | - Clifford F Shipley
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, 2001 South Lincoln Avenue, Urbana, IL 61801, USA
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8
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Abstract
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.
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Sylvester-Hvid A, Avnstorp MB, Fjeld T, Crewe B. Benign tumours leading to total penile denudation treated with Manuka honey dressings: A case report and review of literature. Int J Surg Case Rep 2019; 61:191-194. [PMID: 31377541 PMCID: PMC6677685 DOI: 10.1016/j.ijscr.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/05/2022] Open
Abstract
Penile denudation can be treated either with reconstructive surgery or conservatively using Manuka honey dressings. Split-, full-thickness skin graft or local skin flap are surgical reconstructive possibilities regarding penile denudation. Methylglyoxal is responsible for the antibacterial activity in Manuka honey contrarily to other types of honey. Manuka honey treatment requires a minimum of medical training and be used in the out-patient clinic. A wide variety of wound types can benefit from Manuka honey dressings.
Introduction Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG. Case A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result. Discussion Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care. Conclusion We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.
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Affiliation(s)
- Amalie Sylvester-Hvid
- Department of Plastic- and Breast Surgery, University Hospital Zealand, Sygehusvej 10, DK-4000, Roskilde, Denmark.
| | - Magnus B Avnstorp
- Department of Plastic- and Breast Surgery, University Hospital Zealand, Sygehusvej 10, DK-4000, Roskilde, Denmark.
| | - Tobias Fjeld
- Department of Plastic- and Breast Surgery, University Hospital Zealand, Sygehusvej 10, DK-4000, Roskilde, Denmark.
| | - Bjørn Crewe
- Department of Plastic- and Breast Surgery, University Hospital Zealand, Sygehusvej 10, DK-4000, Roskilde, Denmark.
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10
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Kim JY, Kim JY, Park M, Oh CK, Chung JS, Park SH, Kim SC. Surgical managements of pseudoepitheliomatous keratotic and micaceous balanitis: A case report. Int J Surg Case Rep 2019; 55:37-40. [PMID: 30684817 PMCID: PMC6351345 DOI: 10.1016/j.ijscr.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/29/2018] [Indexed: 11/24/2022] Open
Abstract
Pseudoepitheliomatous keratotic and micaceous balanitis is rare and had the distinctive clinical findings. Deep biopsy is needed to diagnose the accurate tumor staging. Glansectomy with split-thickness skin graft can be performed to treat and diagnose.
Introduction Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an extremely rare disease. Herein, we report a case of PKMB in a patient who underwent two surgical procedures, since the 5-FU cream was not available. Presentation of case A 50 year-old Korean man undergoing circumcision in a local clinic presented with a tumor-like lesion on the glans penis. Peeling the mass was performed to remove the entire mass after an excisional biopsy. A pathologic finding of mass showed hyperkeratotic and papillomatous squamous epithelium without obvious cytologic atypia. Considering that the lesion recurred after 4 weeks, the patient underwent glansectomy with split-thickness skin graft (STSG). There had been no evidence of recurrence at the surgical site during the follow-up at 6 years postoperatively. Discussion If the 5-FU cream is not available, two surgical procedures can be performed for treatment and biopsy. Peeling the mass has the advantage of confirming the characteristics of the whole lesion, but it cannot confirm tumor invasion because it is unable to obtain the subepithelial layer. Glansectomy is able to accurately identify the tumor stage because it removes the tumor and total glans penis and has excellent outcome. Conclusion PKMB is very rare and has a characteristic appearance, which is mica-like crusts and keratotic horny mass on the glans penis. Glansectomy with STSG is a good procedure when the 5-FU cream was not available.
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Affiliation(s)
- Joo Yeon Kim
- Department of Pathology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Ji Yeon Kim
- Department of Pathology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Myungchan Park
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jae-Seung Chung
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang Hyun Park
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea.
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11
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Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital Infections with Sodium Glucose Cotransporter-2 Inhibitors: Occurrence and Management in Patients with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2018; 22:837-842. [PMID: 30766827 PMCID: PMC6330876 DOI: 10.4103/ijem.ijem_159_17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Diabetes is a metabolic disorder characterized by hyperglycemia and is associated with several comorbidities and complications. Genital infection is one such complication that is often associated with diabetes mellitus (DM). Even though abnormalities in immune system, high urine glucose, and bladder dysfunction are important contributors for the increased risk of genitourinary symptoms, yet the possible role of pharmacologically induced glucosuria cannot be completely overlooked in such patients. There are various classes of medications to control blood glucose levels. A new therapeutic option to manage hyperglycemia is to increase renal glucose excretion by inhibiting sodium-glucose cotransporter-2 (SGLT2) glucose transport proteins. SGLT2 inhibitors (SGLT2i) represent a novel class of oral antidiabetic drugs which are associated with drug-induced glucosuria. Currently, canagliflozin, dapagliflozin, and empagliflozin are the three SGLT2i approved for therapy in Type 2 DM (T2DM). Safety studies with these three SGLT2i have reported events of mild-moderate genital infections in patients on SGLT2i therapy. However, most of the reported infections responded to standard treatment. Apart from SGLT2i, factors including personal hygiene, menopause, and circumcision might have a possible role in reported events of genital infections among T2DM patients on SGLT2i therapy. The present review identifies the occurrence of genital infections in diabetic patients on SGLT2i therapy, factors affecting the incidence of genital infections, and management strategies in patients with T2DM on SGLT2i therapy.
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Affiliation(s)
- A. G. Unnikrishnan
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Research Institute of Diabetes, Bharti Hospital, Karnal, Haryana, India
| | - Vedavati Purandare
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Hardik Vasnawala
- Medical Affairs, AstraZeneca Pharma India Ltd., Bengaluru, Karnataka, India
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Boehm A, Bruyère F. [Dermato-urology: Male genital lesions urologist should know]. Prog Urol 2018; 28:251-281. [PMID: 29428190 DOI: 10.1016/j.purol.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion. METHOD This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites". RESULTS It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses. CONCLUSION Any suspicious, fixed, must lead to a skin biopsy.
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Affiliation(s)
- A Boehm
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France.
| | - F Bruyère
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France; Université François-Rabelais de Tours, PRES centre Val-de-Loire, 37000 Tours, France
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Abstract
During complete inspection of skin a variety of penile skin alterations may be found. Not all dermatological findings have clinical relevance. Pearly papules and heterotopic sebaceous glands are physiological variations. Most penile melanotic macules, angiokeratoma, fibroma and angioma have not to be treated. However, other more severe diseases such as malignant skin lesions (erythroplasia of Queyrat), infectious disease (human papillomavirus-induced penile warts) or systemic skin diseases (psoriasis) may be detected. Since patients are alarmed by genital skin lesions and their sexuality may be affected, the initiation of adequate therapy is an important task for urologists and dermatologists.
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14
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Abstract
The urological examination of male patients includes an inspection of the external genitalia whereby a variety of dermatological alterations can be found. Not all dermatological findings are of clinical relevance. Pearly penile papules and heterotopic sebaceous glands are examples of normal physiological variations. Most penile melanotic macules, angiokeratomas, fibromas and angiomas do not have to be treated; however, penile skin lesions may also be symptoms of other diseases, such as circinate balanitis in Reiter's syndrome and multiple angiokeratomas in Fabry's disease. A typical manifestation of reactions to various drugs is the fixed drug eruption of penile skin. The differential diagnosis of various forms of balanoposthitis may be difficult and requires histological investigations (e.g. plasma cell balanitis or Zoon's disease). In contrast, the clinical manifestation of lichen sclerosus et atrophicus is easy to recognize. The clinical relevance of this disease is due to phimosis and problems during sexual intercourse.
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Affiliation(s)
- F M Köhn
- Andrologicum München, Burgstr. 7, 80331, München, Deutschland.
| | - D Schultheiss
- Gemeinschaftspraxis für Dermatologie und Urologie, Gießen, Deutschland
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15
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Abstract
Penile inflammatory skin conditions such as balanitis and posthitis are common, especially in uncircumcised males, and feature prominently in medical consultations. We conducted a systematic review of the medical literature on PubMed, EMBASE, and Cohrane databases using keywords "balanitis," "posthitis," "balanoposthitis," "lichen sclerosus," "penile inflammation," and "inflammation penis," along with "circumcision," "circumcised," and "uncircumcised." Balanitis is the most common inflammatory disease of the penis. The accumulation of yeasts and other microorganisms under the foreskin contributes to inflammation of the surrounding penile tissue. The clinical presentation of inflammatory penile conditions includes itching, tenderness, and pain. Penile inflammation is responsible for significant morbidity, including acquired phimosis, balanoposthitis, and lichen sclerosus. Medical treatment can be challenging and a cost burden to the health system. Reducing prevalence is therefore important. While topical antifungal creams can be used, usually accompanied by advice on hygiene, the definitive treatment is circumcision. Data from meta-analyses showed that circumcised males have a 68% lower prevalence of balanitis than uncircumcised males and that balanitis is accompanied by a 3.8-fold increase in risk of penile cancer. Because of the high prevalence and morbidity of penile inflammation, especially in immunocompromised and diabetic patients, circumcision should be more widely adopted globally and is best performed early in infancy.
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Affiliation(s)
- Brian J. Morris
- Department of Physiology, School of Medical Sciences and Bosch Institute, University of Sydney, New South Wales 2006, Australia
| | - John N. Krieger
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Section of Urology, Seattle, Washington 98108, USA
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16
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Bari O, Cohen PR. Successful Management of Zoon's Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacelluaris. Dermatol Ther (Heidelb) 2017; 7:203-210. [PMID: 28382428 PMCID: PMC5453920 DOI: 10.1007/s13555-017-0178-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Zoon's balanitis, also referred to as balanitis circumscripta plasmacellularis (BCP), is an idiopathic, benign inflammatory condition of the glans penis and foreskin most often seen in elderly uncircumcised men. A patient with a biopsy-confirmed diagnosis of BCP who was successfully treated with topical mupirocin ointment is described. METHODS The PubMed database was searched with the key words: bactroban, balanitis, cell, circumscripta, mupirocin, plasma, plasmacellularis, tacrolimus, Zoon. The papers generated by the search and their references were reviewed. RESULTS Treatments for BCP have previously included circumcision and topical calcineurin inhibitors. Our patient with BCP rapidly resolved after initiating treatment with mupirocin 2% ointment. CONCLUSION BCP is a benign dermatosis affecting the glans penis and foreskin. We confirm an earlier observation demonstrating successful management of this condition with topical mupirocin 2% ointment. Previously reported therapies include circumcision, topical calcineurin inhibitors, phototherapy, and laser therapy. However, based on our observations, topical mupirocin 2% ointment therapy may be considered for the initial management of patients with suspected BCP. Prompt response to mupirocin 2% ointment is highly suggestive of the diagnosis of BCP since morphologically similar skin conditions do not respond to this treatment.
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Affiliation(s)
- Omar Bari
- School of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA.
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17
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Borgia F, Vaccaro M, Foti A, Giuffrida R, Cannavò SP. Zoon's balanitis successfully treated with photodynamic therapy: Case report and literature review. Photodiagnosis Photodyn Ther 2016; 13:347-9. [PMID: 26321748 DOI: 10.1016/j.pdpdt.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Zoon's balanitis (ZB) is an idiopathic chronic condition usually presenting as a solitary erythematous plaque on the glans of primarily uncircumcised, middle-aged to older men. The different treatment options for this condition often achieve partial results, with frequent recurrence after treatment withdrawal. Recently, photodynamic therapy (PDT) has been proposed as therapeutic option with discordant results. We treated a thirty-five year-old man affected by Zoon's balanitis, resistant to conventional treatments, with 3 sessions of topical ALA-PDT at two weeks intervals. At the end of the treatment period notable improvement of clinical features was observed, with almost complete clearance at 3 months' follow-up, high safety profile and absence of durable side-effects.
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18
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Gonzalvo V, Polo A, Serrallach F, Gutiérrez A, Peyri E. Clinical study of the effectiveness of the "water of the 3 sulfates" on balanitis and balanoposthitis. Actas Urol Esp 2015; 39:118-21. [PMID: 25262388 DOI: 10.1016/j.acuro.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Despite scientific literature mentions the application of "water of the 3 sulfates" (copper sulphate, zinc sulphate and alum) as a treatment for acute balanitis and balanoposthitis, no clinical trials evaluating its efficacy have been found. In our study we evaluate the efficacy of this solution in acute balanitis and balanoposthitis. MATERIAL AND METHODS A double-blind randomized study was designed to compare the efficacy of "water of the 3 sulfates" (intervention) with saline solution (control) in 50 patients (30 patients and 20 patients, respectively) who suffer from acute balanitis or balanoposthitis. Exudate, erythema, oedema, burning, and itching were the clinical parameters assessed. RESULTS for all clinical parameters assessed, the outcomes obtained with "water of the 3 sulfates" are higher than control, although significant differences only have been found for exudate. CONCLUSIONS in our study, the "water of the 3 sulfates" is significantly more effective than saline solution for removing exudates in acute balanitis and balanoposthitis. Tolerability was excellent in both treatments.
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Affiliation(s)
- V Gonzalvo
- Servei d'Urología Hospital Lluis Alcanyís de Xàtiva, Xàtiva, España.
| | - A Polo
- Servei d'Urología Hospital Lluis Alcanyís de Xàtiva, Xàtiva, España
| | - F Serrallach
- Servei d'Urología, Hospital Universitari Sagrat Cor, Barcelona, España
| | - A Gutiérrez
- Servei d'Urología, Hospital Universitari Sagrat Cor, Barcelona, España
| | - E Peyri
- Clinica Urológica Dr. Peyri, Barcelona, España
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19
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Binet A, François-Fiquet C, Bouche-Pillon MA. [Review of clinical experience for a new preputioplasty technique as circumcision alternative]. ANN CHIR PLAST ESTH 2015; 61:23-8. [PMID: 25708731 DOI: 10.1016/j.anplas.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique.
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Affiliation(s)
- A Binet
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France.
| | - C François-Fiquet
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France; Service de chirurgie plastique et reconstructrice, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - M A Bouche-Pillon
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France
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20
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Loggia G, Blanchemain S, Claeys D, Lescure P. [A coloured glans penis]. Rev Med Interne 2013; 35:344-5. [PMID: 23958232 DOI: 10.1016/j.revmed.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Affiliation(s)
- G Loggia
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - S Blanchemain
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - D Claeys
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - P Lescure
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
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