Utility of uroflowmetry during the follow-up of children affected by balanitis xerotica obliterans (BXO)

Abstract

We recommend to send for hystological examination all foreskins excised after circumcision. We believe that a clinical and uroflowmetric follow-up of pediatric patients with BXO is mandatory for a prompt identification of post-voiding dysfunction.

Comparison of lichen sclerosus in boys and girls: A systematic literature review of epidemiology, symptoms, genetic background, risk factors, treatment, and prognosis

“…Snodgrass et al 86 found 40% of patients who had circumcision for meatal LS (complete excision, including total replacement of the involved urethra) still had a recurrence of the disease at a median of 2 years. The progression of LS in boys can lead to obstructive urinary tract complications, and in severe cases, even renal failure 85,87 …”

“…LS can be a chronic disease, as seen in the recurrence rate in both sexes after either initial topical therapy in girls or circumcision in boys. 33,35,69,72,[78][79][80][81][82][83][84][85][86][87][88][97][98][99] As discussed earlier, literature often refers to meatal and urethral strictures post-surgery as complications of the circumcision. In our practice, however, we note the meatus is involved prior to circumcision in nearly all cases.…”

“…Little is known about the prognosis of LS in both girls and boys. LS can be a chronic disease, as seen in the recurrence rate in both sexes after either initial topical therapy in girls or circumcision in boys 33,35,69,72,78‐88,97‐99 . As discussed earlier, literature often refers to meatal and urethral strictures post‐surgery as complications of the circumcision.…”

“…11,[65][66][67][68] Tacrolimus (and other topical calcineurin inhibitors), sometimes giving a brief burning sensation at initiation of treatment (16%) 11 Alternatively, for maintenance potent corticosteroid ointment intermittently or less potent corticosteroids 59,69 Surgery for scarring not advised. (Seldom in adolescents in cases of introital stenosis) 28 Emollients 4,6 Circumcision with complete resection of foreskin 6,70 Preputioplasty 71,72 Urethral strictures: Single stage buccal mucosal inlay grafting 73 Preoperative/ postoperative therapy: Moderate or potent corticosteroids e.g., mometasone furoate 0.05% ointment or betamethasone ointment 74,84 or tacrolimus 0.1% 77 Prognosis 20-97% have recurrent signs and/or symptoms despite therapy (0-18 years) 78 Untreated LS may lead to scarring and possibly labial fusion 27,28 Recurrent phimosis, urethral strictures, and meatal stenosis Subsequent meatus surgery in 7-20% (urethral dilatation, meatoplasty) 33,35,[82][83][84] When untreated, LS can lead to obstructive urinary tract complications or renal failure 85,87 In boys, circumcision with complete resection of the foreskin is still considered the ultimate treatment. 6,70 Two studies found preputioplasty combined with intralesional steroid injection to be an effective alternative, though with a higher relapse rate than circumcision.…”

“…Cohort studies show 7-20% of boys circumcised for LS subsequently need a meatal procedure in the form of a meatomy or meatoplasty within weeks to several months. 33,35,[82][83][84] Arena et al 85 using uroflowmetry (UF) to evaluate the outcome of 75 circumcised patients with LS, found that 13.3% had a pathological UF after 1 year requiring progressive urethral dilatation or meatoplasty. 85 Neither an abnormal appearance of the meatus nor meatal intervention during the first surgery seems to have a significant effect on the need of a subsequent operation.…”