Primary cavernous hemangioma of the glans penis with balanitis xerotica obliterans: a case report

The uniqueness of this case is in its rarity and divergent presentation. Here, we report a case of 61 years old diabetic male who presented with painless swelling on the glans penis for the past 6 months along with bleeding from the mass and difficulty to pass urine for 1 month. Examination revealed solid, mass arising from the tip of glans with non-retractile, indurated prepuce. No clinically palpable lymphadenopathy was present. Dorsal slit was performed and mass excised. Histopathology examination revealed cavernous hemangioma. Primary cavernous hemangioma of glans penis is very rare but challenging for urologists to diagnose and manage such cases.

Could a careful clinical examination distinguish physiologic phimosis from balanitis xerotica obliterans in children?

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.

Recent advances in understanding and managing Lichen Sclerosus

Lichen sclerosus (LS), or balanitis xerotica obliterans as it was previously known, is a chronic inflammatory lymphocyte-mediated scarring dermatosis that often affects the preputial skin and glans, leading to phimosis and urethral strictures if left untreated. We present a narrative review of the literature assessing its aetiology and pathogenesis and discuss its links to penile cancer and its medical and surgical management. Possible hypotheses for the development of LS include chronic exposure to trapped urine, leading to changes in the epithelial structure. This is supported by the fact that circumcision is often curative in the early stages of the disease. Although circumcision can be curative, the use of topical steroids is typically the first-line treatment and may preserve the foreskin and forgo the need for circumcision altogether. Patients should be made aware of a possible association with penile cancer. Although the majority of cases can be treated by medical therapy and circumcision, a significant number of patients may also require penile reconstructive procedures.

Lichen sclerosus – A review of the literature

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 discussion: 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.