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Penile Leukoplakia

Balanitis Xerotica Obliterans


Presentation

  • Three patients presented with retention of urine, four had difficulty in passing urine and two patients presented with painful erection.[ajol.info]
  • The clinical presentation and complications of lichen sclerosus are well known. What is less well known is the true incidence of the condition.[ncbi.nlm.nih.gov]
  • Furthermore, on histological examination BXO presents a very characteristic picture. Hyperkeratosis is present and the epidermis is atrophic with thinning of the rete pegs. Vacuolar degeneration of the basal layer may be present.[cirp.org]
  • Features a downloadable Online Image Collection that you can use to enhance your presentations. Presents two brand-new chapters covering urinary cytology and fine needle aspiration to keep you up to date.[books.google.es]
Falling
  • Back to 2016 Fall Congress Increased incidence of balanitis xerotica obliterans in the obese pediatric male Molly E. Fuchs, MD, Daryl J. McLeod, MD, Daniel G. Dajusta, MD. Nationwide Children's Hospital, Columbus, OH, USA.[spuonline.org]
  • Fabry, J.: Ueber einen Fall von Kraurosis penis bei gliechzeitigem Bestehen von Weissflecken am Skrotum, Dermat. Wchnschr. 86 :7 (Jan 7) 1928. 28. Montgomery, H., and Hill, W.: Lichen Sclerosus et Atrophicus, Arch.[cirp.org]
  • Side effects include gastrointestinal upset, diarrhea, vomiting, hair fall and bone marrow suppression. Follow up As the cancer can recur even after surgery and chemoradiation therapy, follow up with your surgeon is important.[medthical.com]
Pallor
  • [new 2015] 1.10 Haematological cancers Leukaemia in adults 1.10.1 Consider a very urgent full blood count (within 48 hours) to assess for leukaemia in adults with any of the following: pallor persistent fatigue unexplained fever unexplained persistent[nice.org.uk]
Easy Bruising
  • The white thin fragile areas, sometimes surrounding the foreskin in a figure of eight pattern, have a crinkly surface; their fragility may lead to easy bruising and erosions. Later on, the foreskin opening can shrink, leading to pain on intercourse.[londoncircumcisioncentre.co.uk]
Localized Scleroderma
  • With experience, the clinical picture of established BXO is almost unmistakable, although the differential diagnosis might include lichen planus, localized scleroderma, leukoplakia, vitiligo and the cutaneous rash of Lyme disease.[cirp.org]
  • scleroderma, leukoplakia, vitiligo, and the cutaneous rash of Lyme disease can have a similar appearance. [21] Treatment [ edit ] Main treatment [ edit ] There is no definitive cure for LS. [22] Behavior change is part of treatment.[en.wikipedia.org]
Hemorrhagic Bullae
  • We noted hemorrhagic bullae in one of our cases early in the course of the disease. Carcinoma may be an eventual development, as exemplified in cases described by Stühmer, Frühwald 20 and Grütz. 5 Fig. 1.[cirp.org]
Follicular Plugging
  • The presence of dells and of follicular plugging is regarded as an important diagnostic aid.[cirp.org]
Paresthesia
  • The disease was accompanied by intense itching and disagreeable paresthesias. Delbanco stated his belief that kraurosis was a disease sui generis differing from the condition in cases of leukoplakia described by Kraus and Fuchs.[cirp.org]
  • , circinate plaques that are often associated with white or silvery scales; usually systemic Carcinoma in situ Infectious lesions Genital herpes Primary disease: constitutional symptoms followed by genital vesicles Recurrent disease: prodromal local paresthesias[aafp.org]
Penile Lesion
  • The management of benign penile lesions usually involves observation or topical corticosteroids; however, neoplastic lesions generally require surgery.[aafp.org]
  • Treatment of Penile lesion T1 G3, T 2 Partial / total amputation. Conservative strategy is an alternative in very carefully selected patients. 22. Treatment of Penile lesion Local recurrence Second conservative procedure. Partial / total amputation.[slideshare.net]
  • However, only 50% of these patients will have cancer in the lymph nodes as these lymph nodes are often "reactive" to inflammation or super-infection in the penile lesion.[bradyurology.blogspot.com]
  • Invasive tumours require staging of the primary penile lesion and inguinal and pelvic lymph nodes. Local staging can be performed using magnetic resonance imaging (MRI).[patient.info]
Genital Lesions
  • The atrophic wrinkling characteristic of lichen sclerosus on other body sites is usually lacking in genital lesions. Figure 1. Penile lichen sclerosus with white hue showing loss of pigment.[dermatologyadvisor.com]
  • Carbon dioxide laser treatment of external genital lesions. Urology 1985; 25 :555-8. Hrebinko RL. Circumferential laser vaporisation for severe meatal stenosis secondary to balanitis xerotica obliterans. J Urol 1996; 156 :1735-6.[cirp.org]
  • Excision of the lesions was curative, without recurrences, in the two patients who had lesions in the oral cavity; follow-up was not available in the cases with genital lesions.[e-ijd.org]
Incontinence
  • Focus on today's hot topics in urology, including stress and mixed urinary incontinence; prolapse therapy; therapy for overactive bladder; and targeted therapy for renal cell carcinoma.[books.google.com]
  • Brandes Springer Science & Business Media, 10 oct. 2008 - 379 páginas Urethral injury may be of secondary importance when the patient comes into the emergency room, but devastating urological complications, such as sexual dysfunction, incontinence, and[books.google.es]
  • Pigment incontinence is usually present. Diagnosis confirmation The key differential diagnosis is lichen planus, which may present with reticulated white lesions on an erythematous background, erosions, ulcerations or polygonal papules.[dermatologyadvisor.com]
  • The symptoms may include frequency, suprapubic pain (pain felt above the pubis ), hematuria (blood in the urine), dysuria (difficult urination or pain during urination), urgency, and urge incontinence.[en.wikipedia.org]
Renal Impairment
  • impairment in a child. ( 18587589 ) Sandler G....Cass D. 2008 30 Urethral reconstruction in balanitis xerotica obliterans. ( 18931544 ) Trivedi S....Singh P.B. 2008 31 The response of clinical balanitis xerotica obliterans to the application of topical[malacards.org]
  • Long standing balanitis xerotica obliterans resulting in renal impairment in a child. Pediatr Surg Int. 2008 Aug. 24(8):961-4. [Medline]. Pugliese JM, Morey AF, Peterson AC.[emedicine.medscape.com]
Urinary Incontinence
  • Focus on today's hot topics in urology, including stress and mixed urinary incontinence; prolapse therapy; therapy for overactive bladder; and targeted therapy for renal cell carcinoma.[books.google.com]

Workup

  • Imaging Metastatic workup should include CXR, bone scan, and CT scan of the abdomen and pelvis. Disseminated disease is present in less than 10% of patients at presentation.[health.am]
Lymphocytes Increased
  • Later, the relative number of lymphocytes increases, and epitheloid and plasma cells may be present. In the subacute phases the lympocytic infiltrate becomes arranged about the vessels.[cirp.org]
Lymphocytic Infiltrate
  • The classic lesion of penile LS occurs relatively late and is characterized by hyperkeratosis of the epithelium, atrophy and loss of the rete pegs, degeneration of the basal cells, sclerosis of the sub epithelial collagen and lymphocytic infiltration[urologyannals.com]

Treatment

  • Treatment Options Potent topical corticosteroids are the mainstay of treatment. In general, the risk of atrophy from uncontrolled disease outweighs the risk of pulse therapy with potent topical corticosteroids.[dermatologyadvisor.com]
  • The treatment of balanitis xerotica obliterans I. Depasquale 1, A.J. Park 1 and A.[cirp.org]
  • Further treatment, or treatment of circumcised patients, is more challenging. Intraurethral steroids provide efficacious therapy for stricture disease in patients with biopsy proven BXO before invasive surgery. 4.[londoncircumcisioncentre.co.uk]
  • No consensus exists about the optimal approach to treatment for balanitis xerotica obliterans. Surgery (including skin grafting), a variety of pharmacologic therapies, and laser treatment have been used with varying degrees of success.[medpagetoday.com]
  • Unfortunately there is no definitive treatment for the condition. BXO requires specialist assessment and treatment and might require joint management from a urologist and dermatologist.[irishhealth.com]

Prognosis

  • Submission of the foreskin for histological analysis should always be considered, as prognosis differs for lichen sclerosus vs nonlichen sclerosus histology. We recommend a care pathway for boys with lichen sclerosus.[f1000.com]
  • The prognosis depends upon several factors and may be guarded Who gets Balanitis Xerotica Obliterans? (Age and Sex Distribution) Balanitis Xerotica Obliterans is a condition of the penis that usually affects men in the 30-50 years age group.[dovemed.com]
  • References: [7] [8] Prognosis[amboss.com]
  • Physical examination is of paramount importance as staging (depth of spread; see below) is most important in determining prognosis.[bradyurology.blogspot.com]
  • Prognosis The prognosis for urachal cancer remains poor with its insidious course and advanced disease at presentation.[abdominalkey.com]

Etiology

  • There appears to be an increased risk for family members to develop LS, suggesting a genetic component to the etiology. General Prevention Neonatal circumcision appears to be protective.[unboundmedicine.com]
  • Operations on the genitals, such as circumcision and dorsal incision, are not etiologic factors in our opinion. In contradistinction to Stühmer's 2 belief that the disease occurs only in young adults, we feel that it may occur at any age.[jamanetwork.com]
  • Etiology: may be idiopathic or may be associated with an underlying carcinoma.[auanet.org]
  • Abstract Background: Balanitis Xerotic obliterans (BXO) or Penile Lichen Sclerosus is a dermatological condition affecting the genitalia and associated with chronic, progressive, sclerosing inflammatory dermatosis of unclear etiology.[ajol.info]
  • While the exact etiology is unclear, BXO is more common in some conditions such as hypospadias and secondary phimosis. The reported rates of BXO in children ranges from 9 - 40%.[spuonline.org]

Epidemiology

  • Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system. South Med J. 2003 Jan. 96(1):9-11. [Medline]. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D.[emedicine.medscape.com]
  • Epidemiology The prevalence is 1 in 300 to 1 in 1,000 men. Peak incidence appears to be 21 to 30 years of age ( 2 ). Neonatal circumcision appears to prevent development of BXO.[unboundmedicine.com]
  • 16060864 ) Kiss A....Merksz M. 2005 39 Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). ( 15351594 ) Peterson A.C....Webster G.D. 2004 40 Balanitis xerotica obliterans: epidemiologic[malacards.org]
  • Epidemiology Rare type of malignancy in industrialized countries More common in developing countries in Africa, South America, and Asia Peak incidence : 60 years of age References: [1] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology Balanitis is more common in men than in boys. It is present in approximately 11% of attendees at genitourinary medicine (GUM) clinics. Balanitis affected 5.9% of uncircumcised boys in one study and 14% in another. Risk factors.[unityskinclinic.com]
Sex distribution
Age distribution

Pathophysiology

  • However, circumcision later in childhood may not be protective; affects foreskin and glans in 57–100%, meatus in 4–37% with involvement of urethra in about 20% Etiology and Pathophysiology The exact cause of BXO is unknown.[unboundmedicine.com]
  • Etiology Pathophysiology Although the pathogenesis is unknown, HLA-subtype susceptibility and high rates of associated autoimmune disorders suggest that the disorder may be autoimmune in nature.[dermatologyadvisor.com]
  • AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma[news-medical.net]
  • Pathophysiology The etiology of male genital lichen sclerosus is unknown, but it is thought to be multifactorial. Balanitis xerotica obliterans (BXO) has occurred in monozygotic twins, which suggests a genetic basis for the disease in some cases.[emedicine.medscape.com]
  • To get free no obligation Quote For Penile Cancer Treatment in India : click here India & International : 91 9371770341 Pathophysiology Penile cancers usually begin as small lesions on the glans or prepuce.[indiacancersurgerysite.com]

Prevention

  • General Prevention Neonatal circumcision appears to be protective. Early diagnosis may allow for earlier treatment to prevent anatomic changes, such as stricture, and prevent malignant change ( 1 ).[unboundmedicine.com]
  • The following factors may be considered towards the preventative steps for Balanitis Xerotica Obliterans: Prevent phimosis by treating any infections early and in a timely fashion Refraining from intense sexual activities or ensuring care during sexual[dovemed.com]
  • Treatment is aimed at the relief of symptoms and prevention of disease progression. Topical steroid therapy is the first-line ther...[5minuteconsult.com]
  • A hard, white ring of tissue often forms on the glans which prevents the foreskin from retracting.[medic8.com]
  • Awareness of the diagnosis and its typical features will enable the patient to receive the correct treatment and prevent further distressing management cul-de-sacs – such as referral to rule out sexually transmitted infection.[pulsetoday.co.uk]

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