Objective: Evaluation of the true incidence of balanitis xerotica obliterans (BXO) among boys younger than 10 years. Methods: In a period of 13 months, 75 boys younger than 10 years were treated for phimosis. Suspicion of BXO was raised in phimosis grade 2 or 3 (classification by Kikiros). Patients were offered primarily either circumcision or conservative therapy and circumcision secondarily (if treatment failed in the conservative group). Each circumcision specimen was examined histopathologically. Results: Circumcision was primarily performed in 29 and secondarily in 17 patients. The mean age was 3.7 years (range 1-10). BXO, chronic inflammation, and normal histological results were found in 8/26/12 (17.4/56.5/26.1%) cases, respectively. The mean follow-up was 8.1 months. No recurrences were reported. Conclusions: The incidence of BXO appears to be higher than previously reported. The clinical appearance in children may be confusing. The preoperative BXO suspicion did not correlate with the final histopathological results.

Keywords:
Phimosis, Balanitis xerotica obliterans, Circumcision, Lichen sclerosus et atrophicus, Clinical appearance
1.
Becker K: Lichen sclerosus in boys. Dtsch Arztebl Int 2011;108:53-58.
2.
Stühmer A: Balanitis xerotica obliterans (post operationem) und ihre Beziehung zur ‘Kraurosis glandis et praeputii penis'. Arch Derm Syphilol 1928;156:613.
3.
Mordeniz C, Verit A: Is circumcision a modified ritual of castration? Urol Int 2009;82:399-403.
4.
Freeman C, Laymon CW: Balanitis xerotica obliterans. Arch Derm Syphilol 1941;44:547.
5.
Catterall RD, Oates JK: Treatment of balanitis xerotica obliterans with hydrocortisone injections. Br J Vener Dis 1962;38:75-77.
6.
Das S, Tunuguntla HS: Balanitis xerotica obliterans - a review. World J Urol 2000;18:382-387.
7.
Kiss A, Kiraly L, Kutasy B, Merksz M: High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol 2005;22:305-308.
8.
Gargollo PC, Kozakewich HP, Bauer SB, Borer JG, Peters CA, Retik AB, Diamond DA: Balanitis xerotica obliterans in boys. J Urol 2005;174:1409-1412.
9.
Kiss A, Csontai A, Pirot L, Nyirady P, Merksz M, Kiraly L: The response of balanitis xerotica obliterans to local steroid application compared with placebo in children. J Urol 2001;165:219-220.
10.
Jayakumar S, Antao B, Bevington O, Furness P, Ninan GK: Balanitis xerotica obliterans in children and its incidence under the age of 5 years. J Pediatr Urol 2012;8:272-275.
11.
Kikiros CS, Beasley SW, Woodward AA: The response of phimosis to local steroid application. Pediatr Surg Int 1993;8:329-332.
12.
Depasquale I, Park AJ, Bracka A: The treatment of balanitis xerotica obliterans. BJU Int 2000;86:459-465.
13.
Powell J, Robson A, Cranston D, Wojnarowska F, Turner R: High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol 2001;145:85-89.
14.
Walkden V, Chia Y, Wojnarowska F: The association of squamous cell carcinoma of the vulva and lichen sclerosus: implications for management and follow-up. J Obstet Gynaecol 1997;17:551-553.
15.
Redman R, Massoll NA, Wilkinson EJ: Association between invasive squamous cell carcinoma of the vulva and ABO blood group. J Low Genit Tract Dis 2005;9:89-92.
16.
Meuli M, Briner J, Hanimann B, Sacher P: Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year follow-up after complete circumcision. J Urol 1994;152:987-989.
17.
Vincent MV, Mackinnon E: The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams. J Pediatr Surg 2005;40:709-712.
18.
Miernik A, Hager S, Frankenschmidt A: Complete removal of the foreskin - why? Urol Int 2011;86:383-387.
19.
Trivedi S, Kumar A, Goyal NK, Dwivedi US, Singh PB: Urethral reconstruction in balanitis xerotica obliterans. Urol Int 2008;81:285-289.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.