High Incidence of Balanitis Xerotica Obliterans in Boys with Phimosis: Prospective 10‐Year Study

Abstract

This prospective study was designed to address the incidence and clinical and histologic characteristics of balanitis xerotica obliterans in a large random pediatric population with phimosis. We investigated 1178 boys who presented consecutively with phimosis between 1991 and 2001. All patients who underwent complete circumcision and surgical specimens were typed histologically as early, intermediate, or late forms of this disorder or as nonspecific chronic inflammation. Patients with balanitis xerotica obliterans were controlled at 1, 6, and 12 months postoperatively, then yearly. Balanitis xerotica obliterans was found in 471 of the 1178 patients (40%), with the highest incidence in boys aged 9 to 11 years (76%). Secondary phimosis occurred in 93% of boys with balanitis xerotica obliterans and in 32% of those without the disorder. In six instances of balanitis xerotica obliterans, meatotomy and in one meatoplasty was performed, as well as circumcision. On histologic evaluation, we found 19% had early, 60% intermediate, and 21% late form of balanitis xerotica obliterans. Glanular lesions disappeared completely within 6 months in 229 out of 231 patients. Our data strongly suggest that the true incidence of childhood balanitis xerotica obliterans is higher than previously assumed. Its incidence peaks in the 9 to 11 years age group, in whom secondary phimosis was almost exclusively caused by balanitis xerotica obliterans.

Why circumcision is a biomedical imperative for the 21stcentury

“…Although once thought to affect only 1% of boys, (90) recent histological examination of the prepuce from 1178 boys circumcised for phimosis found BXO in 40%. (91) Of these, 19%…”

“…Incidence peaked at ages 9-11 (76% of cases). (91) Of 41 paediatric BXO cases in Boston, 52% had been referred for phimosis, 13% for balanitis and 10% for buried penis. (92) Of the 46% who were subsequently circumcised, BXO was found in the meatus of 27%.…”

Benign penile skin anomalies in children: a primer for pediatricians

“…The incidence of the condition is unknown, but most authors agree it is increasing and many cases of phimosis undergoing non-elective circumcision in childhood might be in fact have undiagnosed BXO. [15] Consistently, it was reported that approximately half of prepuces obtained from nonelective circumcisions were consistent with a diagnosis of BXO. [16,17] BXO is diagnosed by histological features including hyperkeratosis and hyperplasia of the squamous mucosa along with homogenous collagen deposition in the upper dermis.…”

“…[16,17] BXO is diagnosed by histological features including hyperkeratosis and hyperplasia of the squamous mucosa along with homogenous collagen deposition in the upper dermis. [15] Clinically, the condition can be suspected in the presence of a white, sclerotic, distal preputial ring (Fig. 1B).…”

Current views on the diagnosis and treatment of genital lichen sclerosus

“…Zabieg obrzezania jest skuteczny w przypadku zmian LS zlokalizowanych na napletku i żołędzi [42][43][44]. W przypadku LS z dużymi zmianami zarostowymi utrudniającymi oddawanie moczu wykonuje się operacje ujścia cewki moczowej lub całej cewki moczowej usprawniające funkcjonowanie narządu [43,[45][46][47][48].…”