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We describe meatal outcomes for boys undergoing circumcision to treat Lichen Sclerosus (LS/BXO) with a focus on those who underwent meatotomy/meatoplasty at circumcision and factors associated with post-circumcision meatal intervention. Retrospective review of patients undergoing circumcision for histologically confirmed LS between 2011 and 2020. Statistical testing was by Chi2 and multivariate analysis. 382 patients underwent circumcision at a mean of 9.1 years (SD 2.9). At circumcision, LS on the glans was documented in 213/365 (58%). Meatal involvement was documented in 74/382 (19%); 25/382 (6.5%) had a meatotomy, 94/382 (25%) had meatal calibration/dilatation and 234/367 (64%) were prescribed post-operative topical steroids. Patients with LS glans or meatal involvement were more likely to have a meatotomy (p = 0.0013) and to receive post-operative steroids (OR 5, p = 0.0001). Post circumcision, 40/382 (10%) required a median of 1 subsequent procedure (range 1–5), 10 (2.6%) underwent dilatation, 30 (7.4%) had a meatotomy. Patients undergoing meatotomy at circumcision had an odds ratio (OR) of 1.2 for subsequent meatotomy (p = 0.027). Analysis based on requirement for any subsequent procedure identified an OR of 3.1 for having had a meatotomy at circumcision (p = 0.022) and an OR of 6.0 of receiving post-operative steroids (p=<0.001). Meatal stenosis following circumcision for LS requiring meatal intervention affected 10% of boys. Meatotomy at circumcision increased the likelihood of subsequent meatal intervention and is therefore not recommended. Level III. • What is currently known about this topic? Few studies advise on meatal management at the time of circumcision for LS; whilst long-term outcomes are rarely reported. • What new information is contained in this article? Meatotomy at circumcision and post-operative topical steroid use was significantly more likely in boys with glans or meatal LS. 10% developed meatal stenosis and meatotomy at circumcision does not appear protective. [ABSTRACT FROM AUTHOR]

Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease affecting the male genitalia that is mostly underdiagnosed and undertreatment. We presented a 40-year-old man with meatal stenosis and an inability to urinate. Discoloration at the tip of the penis was found, and he said it got wider as he grew up. We conducted meatotomy and meatoplasty to release obstruction. Early diagnosis is essential to avoid complications.

Background: The long-term results of internal urethrotomy are poor in stricture urethra. It requires repeated procedures followed up with repeated dilatation. Suprechko in 1886, was the first to describe the use of buccal mucosal graft (BMG). The new technique of dorsal on-lay graft Urethroplasty described by Barbagli in 1995, has been greeted with great amount of enthusiasm through the world. Aims and Objectives: The aim of the study is to evaluate the efficacy of buccal mucosa graft in stricture urethra at our centre. The main objective of this study is to assess early complications in buccal mucosal Urethroplasty. Materials and Methods: It is a prospective study conducted at Stanley medical college, Chennai from October 2011 to February 2013. A total of 13 patients were enrolled in the study. Results: Out of 13 patients, 9 patients underwent dorsal on-lay BMG. 3 patients underwent dorsal on-lay+ventral meatotomy. 2 patients underwent dorsal on-lay+meatoplasty. Only two patients developed immediate post-operative wound infection. One patient developed 1 cm penile skin necrosis at ventral aspect of penis. None of the patient developed significant complications. Conclusion: Dorsal on-lay is the preferred form of graft placement. BMG is the ideal substitute for urethra, especially in medium length urethral stricture. Oral cavity donor site had no significant complications. Failure rate was 15.38%, so dorsal on lay technique is ideal for urethral stricture with longer follow up required.

Background: The long-term results of internal urethrotomy are poor in stricture urethra. It requires repeated procedures followed up with repeated dilatation. Suprechko in 1886, was the first to describe the use of buccal mucosal graft (BMG). The new technique of dorsal on-lay graft Urethroplasty described by Barbagli in 1995, has been greeted with great amount of enthusiasm through the world. Aims and Objectives: The aim of the study is to evaluate the efficacy of buccal mucosa graft in stricture urethra at our centre. The main objective of this study is to assess early complications in buccal mucosal Urethroplasty. Materials and Methods: It is a prospective study conducted at Stanley medical college, Chennai from October 2011 to February 2013. A total of 13 patients were enrolled in the study. Results: Out of 13 patients, 9 patients underwent dorsal on-lay BMG. 3 patients underwent dorsal on-lay+ventral meatotomy. 2 patients underwent dorsal on-lay+meatoplasty. Only two patients developed immediate post-operative wound infection. One patient developed 1 cm penile skin necrosis at ventral aspect of penis. None of the patient developed significant complications. Conclusion: Dorsal on-lay is the preferred form of graft placement. BMG is the ideal substitute for urethra, especially in medium length urethral stricture. Oral cavity donor site had no significant complications. Failure rate was 15.38%, so dorsal on lay technique is ideal for urethral stricture with longer follow up required. [ABSTRACT FROM AUTHOR]

Pananterior urethral stricture involving the penile and bulbar urethra is a challenging urological condition in the Indian population. In India, Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus (LS) is the most common cause of pananterior urethral stricture. Various surgical techniques have been described in the literature for present condition, with varied outcomes. However, there is still a need for a simple and effective procedure to address this problem. Hereby, the authors present a case series that included five male patients with BXO and pananterior urethral stricture who underwent Detubularised Non Augmented (DNA) urethroplasty between January 2022 and December 2022. The median age of the patients was 45 years, with a mean stricture length of 13 cm. The median follow-up period was 11 months. During the procedure, a scroto-perineal incision was made, and the anterior urethra was ventrally cut open from the meatus to the junction of the stricturous and normal urethra. A right-sided Tunica Vaginalis (TV) flap was raised (left is left), and the cut-open anterior urethra was wrapped with the TV flap, creating a “controlled fistula” at the proximal end of the detubularised urethra. The average operative time was 1.5 hours. The success of the procedure was determined by a postoperative peak flow rate of 12 mL/sec or more, with no further need for urethral dilatation or direct vision internal urethrotomy. The procedure was successful in 4 out of 5 cases (80%). One patient developed a narrowed urethra during follow-up and required serial catheter upgradation for urethral dilatation. In conclusion, DNA urethroplasty was found to be a simple and effective treatment option for the notorious pananterior urethral stricture associated with BXO.

ObjectiveTo elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options.Materials and methodsThe Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment.ResultsThe contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed.ConclusionLS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.

Pananterior urethral stricture involving the penile and bulbar urethra is a challenging urological condition in the Indian population. In India, Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus (LS) is the most common cause of pananterior urethral stricture. Various surgical techniques have been described in the literature for present condition, with varied outcomes. However, there is still a need for a simple and effective procedure to address this problem. Hereby, the authors present a case series that included five male patients with BXO and pananterior urethral stricture who underwent Detubularised Non Augmented (DNA) urethroplasty between January 2022 and December 2022. The median age of the patients was 45 years, with a mean stricture length of 13 cm. The median follow-up period was 11 months. During the procedure, a scroto-perineal incision was made, and the anterior urethra was ventrally cut open from the meatus to the junction of the stricturous and normal urethra. A right-sided Tunica Vaginalis (TV) flap was raised (left is left), and the cut-open anterior urethra was wrapped with the TV flap, creating a "controlled fistula" at the proximal end of the detubularised urethra. The average operative time was 1.5 hours. The success of the procedure was determined by a postoperative peak flow rate of 12 mL/sec or more, with no further need for urethral dilatation or direct vision internal urethrotomy. The procedure was successful in 4 out of 5 cases (80%). One patient developed a narrowed urethra during follow-up and required serial catheter upgradation for urethral dilatation. In conclusion, DNA urethroplasty was found to be a simple and effective treatment option for the notorious pananterior urethral stricture associated with BXO. [ABSTRACT FROM AUTHOR]

Introduction: Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision for physiological phimosis (adhesions). Due to parental concerns and misperceptions by general practitioners, nonretractile prepuce is one of the most common indications for referral to a paediatric surgeon in many countries. This study aimed to determine whether preputial adhesiolysis successfully managed symptomatic non-retractile foreskin and therefore prevented the need for circumcision. Methods: A retrospective review was performed of the health records of children who presented with preputial adhesion. We included 65 symptomatic patients (ballooning of the prepuce in all cases and additional dysuria in three cases) who underwent preputial adhesiolysis. All cases were followed up for 2 years. Circumcision was subsequently carried out for patients who developed fibrous scarring resulting in difficult retraction due to the development of thick adhesions or skin fissuring with persistence of symptoms. Results: Of the 65 boys, 58 (89.2%) achieved complete retraction of the prepuce. The remaining 7 boys (10.8%) presented with recurring symptoms and thick fibrosed prepuce, and they underwent circumcision due to the dense adhesions. Histopathological examination of the circumcised prepuces revealed balanitis xerotica obliterans in two cases. Conclusion: Preputial adhesiolysis is a safe and effective treatment for symptomatic preputial adhesions in boys younger than 5 years old. The procedure avoids circumcision and its associated risks. Preputial adhesiolysis should be offered as a primary treatment instead of circumcision.

Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

Lichen sclerosus is a chronic inflammatory condition characterized by irritation and dyspigmentation in the genital and perianal areas. Although this condition can affect any individual, it typically has a bimodal age distribution, occurring most frequently in postmenopausal women followed by prepubertal children. Physical examination often reveals thin, hypopigmented and hyperpigmented patches or plaques in the vulvar, perineal, or perianal region. The exact etiology of lichen sclerosus is unknown but is believed to be multifactorial with a combination of genetic, environmental, infectious, and autoimmune factors. Once diagnosed, this condition has a chronic course and long-term treatment is required to sustain remission. We present a case of lichen sclerosus involving the vulvar, perineal, and perianal regions in an elderly female patient that improved with topical clobetasol. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS) et atrophicus is a known premalignant condition affecting both sexes. Squamous cell carcinoma is the most common malignancy seen in LS et atrophicus. We report a case of 42-year-old female suffering from vulval LS et atrophicus for 12 years who developed squamous cell carcinoma. It is imperative to counsel the patients with LS regarding the malignant potential and actively monitor them for better outcome in terms of survival as well as quality of life.

Purpose: Pathological phimosis in childhood typically results in circumcision. Long-term follow-up data for men circumcised in childhood are lacking. This study sought long-term data regarding satisfaction with circumcision and voiding symptoms from men who had childhood circumcision between 1989 and 2010. Methods: Following ethical approval, a postal survey was sent to males > 17 years who underwent circumcision at an age < 16 years for pathological phimosis. Results: The survey was sent to 177 men, 23 completed surveys were returned [19 histology proven Lichen Sclerosus [LS, BXO], 4 chronic balanitis]. Mean age at circumcision was 9.7 years [range 3-15], at survey 23.5 years [18-37]. Seven [all > 9 years] remembered the decision for circumcision. Four warranted urologist review as adults, three required surgery for voiding symptoms and one still performs structure therapy; all had LS. When asked which treatment option[s] they would have considered; ten of them chose circumcision, nine of them chose preputioplasty, eight of them chose topical creams [two of them chose all three options, one man chose both foreskin preserving options]. Eight agreed with the statement “Having a circumcision in childhood or adolescence had an impact on my adult life”; this was positive in two men but negative in five men-they wouldn’t have chosen circumcision. Conclusions: The response rate to the survey was low, making it difficult to draw firm conclusions. However, even in this limited sample, not all men would choose childhood circumcision for pathological phimosis, data supporting the need for larger studies of alternative treatment options. In addition, some men circumcised for childhood LS had significant voiding difficulties in adulthood.

Background: Studies concerning pediatric lichen sclerosus are limited, and, to date, there have been no studies comparing the course of lichen sclerosus in boys and girls. We sought to examine all publications on boys and girls with lichen sclerosus and assess and compare epidemiology, symptoms and signs, genetic background, risk factors, treatment, and prognosis. Methods: A systematic search was performed in the Embase, Medline, Cochrane, and Web of Science databases. Inclusion criteria were information on children ages 0–18 years and a clinical or histologic diagnosis of lichen sclerosus. Literature from 1985 to 2021 was reviewed. Results: A total of 1780 articles were retrieved from the search, of which 90 articles were eligible for inclusion. Boys and girls present similarly on many aspects; nonetheless, treatment and follow‐up are approached differently. Conclusions: Though the clinical approach is often different, lichen sclerosus in boys and girls demonstrates many similarities. More research is needed, especially on follow‐up, to gain a better understanding of the course of lichen sclerosus and establish an advanced management plan for children. [ABSTRACT FROM AUTHOR]

Introduction: Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision for physiological phimosis (adhesions). Due to parental concerns and misperceptions by general practitioners, nonretractile prepuce is one of the most common indications for referral to a paediatric surgeon in many countries. This study aimed to determine whether preputial adhesiolysis successfully managed symptomatic non-retractile foreskin and therefore prevented the need for circumcision. Methods: A retrospective review was performed of the health records of children who presented with preputial adhesion. We included 65 symptomatic patients (ballooning of the prepuce in all cases and additional dysuria in three cases) who underwent preputial adhesiolysis. All cases were followed up for 2 years. Circumcision was subsequently carried out for patients who developed fibrous scarring resulting in difficult retraction due to the development of thick adhesions or skin fissuring with persistence of symptoms. Results: Of the 65 boys, 58 (89.2%) achieved complete retraction of the prepuce. The remaining 7 boys (10.8%) presented with recurring symptoms and thick fibrosed prepuce, and they underwent circumcision due to the dense adhesions. Histopathological examination of the circumcised prepuces revealed balanitis xerotica obliterans in two cases. Conclusion: Preputial adhesiolysis is a safe and effective treatment for symptomatic preputial adhesions in boys younger than 5 years old. The procedure avoids circumcision and its associated risks. Preputial adhesiolysis should be offered as a primary treatment instead of circumcision. [ABSTRACT FROM AUTHOR]

Objectives: To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis xerotica obliterans (BXO) and (ii) patient outcomes to inform future study design. Patients and Methods: Approval was obtained from the UK Health Research Authority and local Research Ethics Committee (Reference 16/NW/0364) and the trial protocol registered with ClinicalTrials.gov (NCT02854995). A total of 20 boys (aged 2–16 years) with BXO were randomised to either circumcision or PIT (online parallel group 1:1 allocation, non‐blinded). Exclusion criteria were: (i) previous penile surgery and (ii) contraindication for either treatment. Follow‐up (including satisfaction questionnaire) was at 6 weeks, 3 and 12 months. Data are presented as median (interquartile range [IQR]), continuous variables were compared by t‐test. Results: A total of 54 boys were approached over 18 months: 23 (45%) were recruited and randomised. The commonest reason for non‐entry was treatment preference: 12 preferred circumcision, 18 preferred PIT. Four patients withdrew after randomisation, three did not want circumcision and one did not want PIT. The groups were similar in terms of age (median [IQR] 11 [6–12] vs 8 [7–10] years, P = 0.53) and duration of symptoms (median [IQR] 6 [6–15] vs 6 [2–24] months, P = 0.77). There were no protocol breaches, serious adverse events or postoperative meatal stenosis. There was one self‐resolving haematoma after PIT and one suture granuloma after circumcision. Two boys went on to have a circumcision after PIT. Overall, satisfaction levels were high for both groups. Conclusion: A definitive RCT of circumcision vs PIT for BXO appears feasible, with 39% of those approached completing the trial. More families preferred PIT. A robust comparison in the form of a multicentred RCT is required. [ABSTRACT FROM AUTHOR]

Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease affecting the male genitalia that is mostly underdiagnosed and undertreatment. We presented a 40-year-old man with meatal stenosis and an inability to urinate. Discoloration at the tip of the penis was found, and he said it got wider as he grew up. We conducted meatotomy and meatoplasty to release obstruction. Early diagnosis is essential to avoid complications., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)

Competing Interests: Conflicts of interest None declared.

Competing Interests: None disclosed.

Balanitis Xerotica Obliterans is a chronic, progressive, sclerosing inflammation of unclear etiology. It involves the external genitalia of males and more specifically the prepuce and its frenulum, the glans, and the external urethral meatus while it may extend to the peripheral part of the urethra. Recent studies have noted an increasing incidence in the paediatric population. It is the most common cause of secondary (pathologic) phimosis. Even more, in boys with physiologic phimosis that does not respond to conservative treatment, Balanitis Xerotica Obliterans should be considered as the underlying condition. In this study, we present all the latest data and attempt to create a diagnostic and curative algorithm regarding this condition. [ABSTRACT FROM AUTHOR]

The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not routinely practiced in South America. Although it is logical to assume that male genital dermatoses are more prevalent in Hispanic men, they are underrepresented in the existing literature. Objective: To describe the epidemiological characteristics from our male genital dermatology unit in Montevideo (Uruguay), the diagnoses, and correlate them with circumcision status and comorbidities. Methods: A retrospective observational cohort study was conducted. A dermatologist and urologist evaluated all patients using standard questionnaires. In 3 years and 8 months, 269 patients were seen. Median age was 41, prevalence of neonatal circumcision was 0.7%, HIV was 4.2%, STIs were 24.9%, non-STIs were 63.9%, and both (STI + non-STI) were 11.2%. Most frequent entities: eczema/balanoposthitis (27.1%), condyloma (24.9%), and lichen sclerosus (15.6%). Data correlating circumcision and other diagnoses did not reach statistical significance. HIV was positively associated with other STIs (p < 0.05), and an association with balanoposthitis was seen; however, it did not reach statistical significance (p < 0.1). Main limitation was small sample size. This is the first study of its kind based on Hispanic patients. Collaboration between specialties proved to be fundamental. Further studies are needed in this demographic to find an association between circumcision, comorbidities, and genital dermatoses. [ABSTRACT FROM AUTHOR]

Background: Genital lichen sclerosus (LS) is a chronic, autoimmune, inflammatory dermatosis of genitalia more common in females than males. Diagnosis of early genital LS is difficult clinically; hence, histopathology may help to confirm the diagnosis. Aims: The aim of this retrospective study was to elucidate the epidemiology of genital LS and to correlate the clinical and histopathological features of genital LS. Methods: Records of 30 clinically diagnosed patients of genital LS with 27 biopsies included in the study. Clinical data from the records reviewed. Histopathological parameters noted and accordingly cases classified into early, evolved, and mature LS and correlated with clinical features. Results: Genital LS was more common in females with early age of onset. Adult patients had longer duration of disease. Pruritus was the most common symptom and females were more symptomatic. Hypothyroidism was the associated autoimmune disease in two cases. Out of thirty patients, six had genital with perianal involvement and two had genital with the extragenital disease. Phimosis was the most common complication in males, while introital stenosis was the most common in females. Lymphohistiocytic infiltrate was the most common histopathological finding followed by hyperkeratosis, dilated blood vessels and lymphatics, and collagen homogenization. Duration, symptoms, and clinical features were found to be independent of the histopathology findings. Limitations: It is a retrospective study with limited patient information. Association of genital LS with other autoimmune diseases cannot be commented as required investigations were not done. Our data are cross-sectional without follow-up, hence the disease course and treatment outcome could not be commented. Conclusions: Genital LS is prevalent in adult females but childhood occurrence is uncommon. Perianal affection occurs almost exclusively in women with genital LS. Understanding variations in histopathologic features is vital to appropriate clinicopathologic correlation. Long-term follow-up is recommended.

The diagnosis of balanitis xerotica obliterans (BXO) in children may be challenging, since clinical examination only could lead to an underestimation of its incidence. The aim of this retrospective and single-centre study is to assess the diagnostic performance of clinical examination, together with clinical history, in identifying BXO. Ninety-seven children underwent circumcision for phimosis from 2015 to 2019. Histology was routinely performed. Cohen's kappa coefficient, sensitivity, specificity, predictive values, likelihood ratios and accuracy of macroscopic appearance of the foreskin, steroid administration and past medical history were estimated. Forty-eight patients (50%) were affected by BXO; 31 of them (69%) presented with suggestive clinical signs. A strictured or whitish urethral meatus was detected during surgery in nine cases (19%); this was associated to allergic or immune diseases (p = 0.046). Foreskin appearance alone mildly correlated with histology (k = 0.494; p < 0.001) and it showed a diagnostic accuracy of 75%. The specificity and positive predictive value of abnormal macroscopic findings at examination, together with a positive clinical history for other allergic or immune diseases, and/or for balanitis, were 100% and the positive likelihood ratio was greater than 10. Conversely, sensitivity decreased to 4.5% (95% CI 0–11%). Conclusion: Foreskin appearance together with clinical history could predict BXO with certainty. However, since the absence of a positive medical history could not exclude the diagnosis, foreskin histology is still highly recommended. What is Known: • Occurrence of balanitis xerotica obliterans may be underestimated in children and it could lead to long-term complications. • The diagnostic accuracy of clinical examination is controversial. What is New: • Clinical signs together with patients' medical history present high specificity and positive predictive values but low sensitivity. • When suggestive clinical aspects are present, patient should be referred to surgery avoiding prolonged conservative treatment; and preputial histology is highly recommended. [ABSTRACT FROM AUTHOR]

Introduction Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. Aim The aim of this study was to report outcomes of therapeutic circumcision from our center. Methods Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services. Results Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3–16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% (n = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% (n = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% (n = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%. Conclusion Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.

Taiki Kato,1 Kentaro Mizuno,2 Hidenori Nishio,2 Yoshinobu Moritoki,1 Akihiro Nakane,1 Satoshi Kurokawa,1 Hideyuki Kamisawa,1 Tetsuji Maruyama,3 Takahiro Yasui,1 Yutaro Hayashi2 1Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan; 2Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan; 3Department of Urology, Nagoya City East Medical Center, Wakamizu, Chikusa-ku, Nagoya, Japan Introduction: Lichen sclerosus (LS), or balanitis xerotica obliterans, is a chronic, inflammatory disease accompanied by cicatrizing skin conditions resulting in pathologic phimosis. LS can be detected clinically by the whitish appearance of the glans or the foreskin, thickened, nonretractable foreskin, dysuria, and spraying. However, diagnosis is confirmed histopathologically. Purpose: The aim of this study was to investigate whether LS can be diagnosed on the basis of clinical manifestation and symptoms. Patients and methods: A retrospective analysis was performed, which included boys referred to our institutions for phimosis evaluation between May 2001 and December 2016. Pediatric urologists clinically diagnosed LS preoperatively. Boys with voiding problems, recurrent balanoposthitis, or who were unresponsive to topical steroid treatment underwent surgical treatment. Patients who underwent religious circumcisions were not included. Results: Three-hundred twenty boys diagnosed with phimosis were identified, and 71 (22%) boys underwent surgery. Fifty-eight boys underwent complete or partial circumcision, and 13 boys underwent a dorsal slit or preputioplasty. Thirty foreskin samples were sent for histopathologic examination. Histopathologic evaluation showed evidence of LS in 13 of 30 (43%) circumcised boys, chronic inflammation in ten (33%), no abnormality in four (13%), dysplasia in two (7%), and acute inflammation in one (3%). In the 22 boys who were clinically diagnosed with LS, 13 patients had histopathologic evidence of LS (59%). Visually, eleven cases had whitish foreskins and 21 cases had thickened nonretractable foreskins, of which there were seven (64%) (P>0.05) and 12 (57%) (P0.2). Conclusion: It is difficult to reliably distinguish whether a patient has histopathological LS by clinical findings alone. Keywords: balanitis xerotica obliterans, lichen sclerosus, circumcision, histology, child

Introduction: To evaluate the outcome of circumcised patients with balanitis xerotica obliterans (BXO) using uroflowmetry (UF). Methods: Between 2011 and 2013, 180 children underwent a circumcision for phimosis. The foreskin was examined on microscopy. Patients with an histological diagnosis of BXO were included in the study. Patients with BXO underwent UF two weeks after surgery and treatment with clobetasol propionate ointment. Patients were re-evaluated at 6, 12, 18 and 24 months postoperatively clinically and using UF. Results: 75 of 180 circumcised patients (41.6%) were included. At two weeks, Thirtytwo of 75 patients (42.7%) displayed a pathological UF. At six months, 15 patients (20%) had pathological UF and a new cycle of clobetasol was prescribed. At one year, 10 patients (13.3%) displayed patholgocial UF and underwent progressive urethral dilatation or meatoplasty. At 18 months, 71 patients (94.7%) displayed regular UF, 3 underwent a meatoplasty and one a staged urethroplasty for a severe urethral stenosis. At two years, UF was normal in 74 out of 75 (98.7%). Conclusions: 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.

Introduction: Balanitis xerotica obliterans (BXO) is an inflammatory disease of unknown etiology and pathogenesis, that represents genital form of lichen sclerosus. Disease is located on foreskin, glans of penis and on urethra. It was discovered that BXO is common cause of phimosis. There is evidence of connections between balanitis xerotica obliterans and appearance of squamous cell carcinoma. The diagnosis of the disease can be clinical and pathohistological. Therapy can be conservative and surgical. The Aim: Determining the frequency of BXO among the boys with phimosis in the light of increasing number of evidence about importance of this clinical entity in development of many complications of urogenital system. Material and methods: Our research contained 470 male patients aged from 1 to 18 years. All the patients who were included in the study were surgically treated in period from 1. January 2014. till 1. January 2017. in University Children's Hospital and all of them had diagnosed phimosis. All the patients underwent circumcision. Foreskins that were suspicious of BXO diagnosis, but could not be diagnosed clinically, were sent to pathohistological analysis. Statistical methods used for measuring central tendency and for determining frequency of BXO were methods of descriptive statistics, or frequency analysis in IBM SPSS Statistics 22 program. Results: Patients with phimosis were in average age of 9.12 ± 4.46 (1-18) years. After data analysis, it was established that in the group of 470 patients there are 48 with BXO diagnosis (10.21%). Patients with BXO were in average age of 10.33 ± 3.14 (6-18) years. Conclusion: Our research has shown that the frequency of BXO among boys with phimosis population is coherent with results of other studies. We concluded that pathohistological analysis of the foreskin is necessary to avoid false negative results after clinical examination.

Ultrapotent topical corticosteroids and circumcision are usually effective for male genital lichen sclerosus (MGLSc); however, refractory cases are often referred to our Male Genital Dermatology Unit. Treatment with autologous platelet‐rich plasma (TPRP) has recently been advocated as a safe and effective treatment option, but there have been no prospective studies in men to date. The objective of this study is to assess the safety and efficacy of TPRP for MGLSc resistant to conventional therapy. A prospective, open‐label, single‐arm, therapeutic study was carried out in this study. Inclusion criteria: resistant to conventional therapy for at least 6 months. Procedure: infiltration of 0.1 mL/cm2 PRP every 8 weeks. Monthly data recording: visual appearance with photographs and external scoring by an expert using Investigator's Global Assessment Scale (IGA scale 0‐5), symptoms (scale 0‐5), quality of life (QoL; Dermatology Life Quality Index [DLQI]), and complications. No. of patients included was n = 5. No. of patients excluded during treatment was n = 1. Mean initial IGA: 3.6. Mean initial DLQI: 6. TPRP n = 34 (range: 2‐9; average: 6.8 per patient). Mean IGA at 18 months: 3.25. Mean DLQI at 18 months: 1.25. All patients reported being completely asymptomatic at 10 months. No. of patients with complications is n = 1 (balanitis). TPRP seems to be safe and effective, regarding symptom control and improvement in QoL; however, visual changes were minimal. [ABSTRACT FROM AUTHOR]

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis which may lead to scarring and atrophy of the tissues. It has predilection for the skin and mucoses of anogenital area in men, women and children. The extragenital lesions occur less frequently. The most common symptoms are itching, pain and dyspareunia. The true prevalence of this disease is unknown and probably underestimated due to the underdiagnosis. Therapy of LS often causes many difficulties. Aim: The aim of our review of the literature is to discuss the diagnostic and therapeutic difficulties of LS that may come across doctors of various specializations. We reviewed the literature regarding the etiology, clinical, medical and surgical management of LS. Material and methods: We performed a comprehensive research of the literature in PubMed, Medline and other electronic databases between 1956-2019 using the key words: 'lichen sclerosus,' 'balanitis xerotica obliterans,' 'kaurosis vulvae.' We reviewed 54 articles. Results and discuss ion: The clinical features and the management vary depending on the age and sex of the patient. To properly treat and prevent possible complications of LS, an interdisciplinary approach to patients care and timely diagnosis of the disease are extremely important. The essence of treatment is to control symptoms, prevent and treat complications and search for early signs of cancer. Conclusions: LS is a disease that presents numerous challenges for doctors specializing in dermatology, gynecology, urology and pediatrics. An interdisciplinary approach is crucial to achieve therapeutic success and patient's satisfaction. [ABSTRACT FROM AUTHOR]

Purpose of Review: Lichen sclerosus (LS) is a chronic inflammatory skin condition that can cause debilitating sexual and urinary sequelae in men and women. In this review, we discuss the etiology, clinical presentation, and management options for genital LS. Recent Findings: While medical and surgical management of LS has remained similar for quite some time, techniques such as the Kulkarni urethroplasty have made one stage reconstruction for panurethral LS strictures more feasible. Perineal urethrostomy has become an increasingly preferred treatment modality for complex LS patients. Current LS research has focused on the pathophysiology of the LS at the protein level and possible targets for treatment. Summary: While exact etiology of LS remains unknown, many theories have been hypothesized. The mainstay of medical treatment includes topical steroids. Various reconstructive techniques may be used depending on patient symptoms, extent of involvement, and the location of disease. Non-genital skin grafts, such as buccal mucosa, are recommended in LS patients requiring grafting for urethral reconstruction. Genital skin flaps are not recommended, as they have a high failure rate in this setting. Long-term follow-up is recommended, as LS can be associated with the development of squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS), (balanitis xerotica obliterans), causes pathological phimosis. Many boys present with obstructive symptoms, the cause is usually obvious on examination so ultrasound scans (USS) of the urinary tract are not routinely indicated. We review a series of abnormal USS in boys with LS. Retrospective note review for boys undergoing surgical treatment for LS between 2000 and 2017. Seventy-eight boys had a USS prior to surgery, those with abnormal USS form the study population. Boys with neuropathic bladder or congenital urinary tract abnormalities were excluded. Nineteen of 78 boys (24%), mean age 9 years, were included. Seventeen had obstructive symptoms, 13 had culture proven UTIs, 12 had new onset incontinence. On USS 3 (17%) had acute retention, 8 (78%) had an isolated post-void residual volume (PVR) > 10% of estimated bladder capacity (EBC); 3 had bladder wall thickening +/− PVR > 10%, 5 had upper tract changes. Symptoms resolved with successful treatment of LS. Six boys had post treatment USS, abnormalities resolved in 5. Clinicians should consider LS in boys presenting with UTIs, new onset incontinence and obstructive urinary tract symptoms. Routine USS are not indicated though should be considered in those with an atypical history or examination. Case Series. Level 4. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS) is a severe, chronic, dermatosis characterised by inflammatory, sclerotic, pruritic lesions that causes significant morbidity in patients of all genders and ages. In boys, the lesions typically affect the foreskin and glans (termed balanitis xerotica obliterans (BXO)), leading to phimosis and potentially meatal stenosis. The incidence of the disease is not well reported but the average age of affected boys is 8 years (range 1-16). Diagnosis can often be made clinically, although histological study remains important to rule out important differential diagnoses. Complications include genital scarring, urinary and sexual dysfunction as well as the development of carcinomas in adult life. Circumcision has been regarded as definitive management of BXO in boys, but this may be supplemented with medical therapies such as topical steroids, immune modulators, intralesional triamcinolone and ozonated olive oil. Supportive measures including emollients, avoidance of irritants, surveillance of complications and recurrence as well as education and counselling remain important.Conclusion: BXO remains an important cause of phimosis in boys. The frequency of this condition appears unclear but seems likely to be less than 1% of males. Treatment generally involves circumcision, with some evidence that topical steroids or immunomodulators may decrease the incidence of recurrent meatal stenosis.What is Known:• Surgical circumcision is considered the definitive management of BXO• Many aspects of BXO are still in contention or require further study including the epidemiology and aetiology.What is New:• There is increasing awareness of non-surgical modalities that may be used in adjunct to surgery including topical corticosteroids, immune modulators, intralesional triamcinolone and ozonated olive oil• Awareness of meatal stenosis-related BXO has led to the development of surgical techniques such as preputioplasty as well as buccal mucosal inlay grafts. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucous membranes, which usually involves the genitals and anus. All patients with itchy symptoms from genitals or atrophic lesions, as well as indurations in this area, should be examined at least once by a physician experienced in the diagnosis and treatment of the diseases in the anogenital area. Early diagnosis and treatment of LS may reduce or prevent scarring within the lesion. In most cases the diagnosis is based on the typical clinical presentation. Diagnostic biopsies should be performed only under certain circumstances. The gold standard for the treatment of LS is the use of strong and very strong topical corticosteroids, but mild and moderate forms of the disease in males can be treated by surgical methods such as circumcision. It is necessary to avoid certain triggers that can cause the appearance of lesions.

Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed PRISMA-compliant keyword searches of PubMed, EMBASE, SCOPUS, LexisNexis, and other databases and identified 61 articles that met the inclusion criteria. In the bibliographies of these articles, we identified 58 more relevant articles and 28 internet items. We found high-quality evidence that NMC is a low-risk procedure that provides immediate and lifetime medical and health benefits and only rarely leads to later adverse effects on sexual function or pleasure. Given this evidence, we conclude that discouraging or denying NMC is unethical from the perspective of the United Nations Convention on the Rights of the Child, which emphasizes the right to health. Further, case law supports the legality of NMC. We found, conversely, that the ethical arguments against NMC rely on distortions of the medical evidence. Thus, NMC, by experienced operators using available safety precautions, appears to be both legal and ethical. Consistent with this conclusion, all of the evidence-based pediatric policies that we reviewed describe NMC as low-risk and beneficial to public health. We calculated that a reduction in NMC in the United States from 80% to 10% would substantially increase the cases of adverse medical conditions. The present findings thus support the evidence-based NMC policy statements and are inconsistent with the non-evidence-based policies that discourage NMC. On balance, the arguments and evidence reviewed here indicate that NMC is a medically beneficial and ethical public health intervention early in life because it reduces suffering, deaths, cases, and costs of treating adverse medical conditions throughout the lifetimes of circumcised individuals., Competing Interests: Brian Morris is a member of the of the Circumcision Academy of Australia, a not-for-profit, government registered, medical society whose website https://circumcisonaustralia.org provides evidence-based information on male circumcision to parents, practitioners and others, as well as contact details of doctors in Australia and New Zealand who perform the procedure. Some of Brian Morris’ research is supported by U.S. National Institutes of Health Center of Biomedical Research Excellence grant 1P20GM125526-01A1 but none of this funding was used for the present study, nor did the funder have any influence on the study., (Copyright © 2024, Morris et al.)