Urologic dermatology: a comprehensive foray into the noninfectious etiologies of balanitis.

Balanitis is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis). Several investigations have found that a sizable proportion of urology clinic visits are due to balanitis or related complaints. Balanitis can have numerous complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and if untreated, malignancy. Unfortunately, there is no recent or comprehensive review that describes the various etiologies, clinical workup, and treatments for balanitis. Herein this review, we attempt to provide the reader with a complete and updated guide to balanitis in an attempt to improve clinical outcomes.

Diabetes and balanoposthitis.

This review describes the association of balanoposthitis with diabetes. It reviews the multifaceted relationship of both conditions, and summarizes the etiology, clinical features and treatment options for this condition. The commonest etiology of balanoposthitis in males with diabetes is Candida, and the mainstay of treatment is maintenance of hygiene, euglycaemia, and eradication of infection. The review sensitizes diabetes care providers to take a history and perform a physical examination in persons with penile symptoms, and also encourages dermatology care providers to screen for diabetes in such persons.

[Meatoplasty with pedicle flap for meatal stenosis secondary to chronic balanitis].

OBJECTIVE: To evaluate the effect of meatoplasty with the pedicle flap in the treatment of meatal stenosis secondary to chronic balanitis. METHODS: We retrospectively analyzed 32 cases of meatal stenosis secondary to chronic balanitis treated by meato- plasty with the pedicle flap. All the patients had a history of chronic balanitis and had received meatal dilatation or simple ventral mea- totomy without significant effect. Their mean maximum urinary flow rate (Qmax) was (4.3 ± 2.4) ml/s. During the operation, A "/\"-shaped incision was made in the healthy epidermis and a flap was harvested from the frenulum. After complete removal of the scar, the flap was placed into the urethral wall, followed by reconstruction of the external urethral orifice. RESULTS: The patients were fol- lowed up for 6 to 30 months, which revealed smooth urination in all the patients with Qmax of (26.7 ± 4.5) ml/s and normal erectile function and uresiesthesis. CONCLUSION: With little invasiveness and few complications, meatoplasty with the pedicle flap is an ideal surgical method for the treatment of meatal stenosis secondary to chronic balanitis. However, there might be some change in the normal appearance of the balanus postoperatively, and its long-term effect needs further observation.

Balanitis is a risk factor for herpes zoster.

Both balanitis and herpes zoster (HZ) may be influenced by the immune system. The objective of this study was to investigate the association between balanitis and HZ. We selected patients aged 20 years and older who were newly diagnosed with balanitis from 2000 to 2010 through the Longitudinal Health Insurance Database 2000. The non-balanitis cohort consisted of randomly selected patients who were matched to the balanitis cohort by age. Distributions of age and comorbidities were compared between the balanitis and non-balanitis cohorts; the categorical variables were examined using a Chi-squared test and the continuous variables were examined using a t-test. Univariable and multivariable Cox proportional hazards regression models were used to estimate the hazard ratios and 95 % confidence intervals for HZ among the balanitis patients in relation to the non-balanitis patients. We identified 4,028 patients with balanitis who were matched based on age with 16,112 patients without balanitis. By the end of the 12-year follow-up, the patients with balanitis had a significantly higher cumulative incidence of HZ than the non-balanitis patients. The risk of HZ for patients without comorbidities was 1.54-fold higher in the balanitis cohort than in the non-balanitis cohort. The higher risk of HZ occurred during the first 6 years of follow-up after a diagnosis of balanitis. Balanitis is a risk factor for HZ. Men with balanitis have a higher risk of developing HZ. HZ vaccination might be necessary for men with balanitis.

Tromboflebitis de Mondor del pene tras hernioplastia inguinal / Mondor's thrombophlebitis of the penis after inguinal hernioplasty

Paciente de 22 años de edad con antecedentes de salud. Hacía un mes se le había practicado una hernioplastia inguinal izquierda, y aproximadamente dos semanas después, comenzó a presentar aumento de volumen y dolor en el dorso del pene, tanto al tacto como con la erección. Al examen físico se constató, que la vena dorsal superficial del pene estaba aumentada de volumen, de color rojizo y dolorosa a la palpación. En el ultrasonido doppler-color peniano, se comprobó el engrosamiento de la pared de dicha vena, trombosis de esta, disminución del flujo sanguíneo, así como dolor al contacto del transductor. Se le indicó reposo sexual, tratamiento con antiinflamatorios no esteroideos y corticoides orales, además de iontoforesis local con pomada de heparina sódica. El paciente evolucionó satisfactoriamente, con la desaparición del dolor y la recanalización de la vena dorsal del pene. La aparición de la tromboflebitis de Mondor del pene, con posterioridad a una hernioplastia inguinal, es excepcional. Su sospecha clínica más la confirmación con el ultrasonido doppler-color, son pilares básicos para el diagnóstico de certeza. El tratamiento conservador ofrece óptimos resultados(AU)

A male patient aged 22 years with a history of health problems. One month before, he had undergone left inguinal hernioplasty, but two weeks after surgery, he began suffering pain in the back of the penis together with increased volume, both on touch and at erect state. The physical examination revealed that the superficial dorsal vein of the penis was more swollen, red-colored and painful on palpation. Doppler-color ultrasound of the penis confirmed thickening of the vein wall, thrombosis, lower blood flow and patient's feeling of pain when the transducer touched it. He was prescribed non-steroidal anti-inflammatory drugs plus oral corticosteroids, cessation of sexual intercourse, in addition to local ionphoresis with sodium heparin ointment. The patient's progression was satisfactory since pain disappeared and the dorsal vein of the penis was re-canalized. Mondor's thrombophlebitis of the penis rarely occurs after inguinal hernioplasty. Clinical suspicion plus Doppler-color US confirmation are basic pillars for a correct diagnosis. The conservative treatment offers optimal outcomes(AU)

Tromboflebitis de Mondor del pene tras hernioplastia inguinal / Mondor's thrombophlebitis of the penis after inguinal hernioplasty

Paciente de 22 años de edad con antecedentes de salud. Hacía un mes se le había practicado una hernioplastia inguinal izquierda, y aproximadamente dos semanas después, comenzó a presentar aumento de volumen y dolor en el dorso del pene, tanto al tacto como con la erección. Al examen físico se constató, que la vena dorsal superficial del pene estaba aumentada de volumen, de color rojizo y dolorosa a la palpación. En el ultrasonido doppler-color peniano, se comprobó el engrosamiento de la pared de dicha vena, trombosis de esta, disminución del flujo sanguíneo, así como dolor al contacto del transductor. Se le indicó reposo sexual, tratamiento con antiinflamatorios no esteroideos y corticoides orales, además de iontoforesis local con pomada de heparina sódica. El paciente evolucionó satisfactoriamente, con la desaparición del dolor y la recanalización de la vena dorsal del pene. La aparición de la tromboflebitis de Mondor del pene, con posterioridad a una hernioplastia inguinal, es excepcional. Su sospecha clínica más la confirmación con el ultrasonido doppler-color, son pilares básicos para el diagnóstico de certeza. El tratamiento conservador ofrece óptimos resultados.

A male patient aged 22 years with a history of health problems. One month before, he had undergone left inguinal hernioplasty, but two weeks after surgery, he began suffering pain in the back of the penis together with increased volume, both on touch and at erect state. The physical examination revealed that the superficial dorsal vein of the penis was more swollen, red-colored and painful on palpation. Doppler-color ultrasound of the penis confirmed thickening of the vein wall, thrombosis, lower blood flow and patient's feeling of pain when the transducer touched it. He was prescribed non-steroidal anti-inflammatory drugs plus oral corticosteroids, cessation of sexual intercourse, in addition to local ionphoresis with sodium heparin ointment. The patient's progression was satisfactory since pain disappeared and the dorsal vein of the penis was re-canalized. Mondor's thrombophlebitis of the penis rarely occurs after inguinal hernioplasty. Clinical suspicion plus Doppler-color US confirmation are basic pillars for a correct diagnosis. The conservative treatment offers optimal outcomes.

[Zoon's balanitis in circumcised and HIV infected man, at Cotonou (Benin)]. / Balanite de Zoon chez un homme circoncis et infecté par le VIH, à Cotonou (Bénin).

Balanitis of Zoon (BZ) characterized by an important plasma cell infiltration occurs exclusively in uncircumcised men aged between 40-80 years. We report here a case of BZ in an HIV infected patient who was circumcised since birth. A 43-year old man consulted in 2009 for itchy and not painful glans erosion evolving for one year. He is HIV1 infected and has been under didanosine, lamiduvine and nelfinavir for three years. Under this treatment, his CD4 count increased from 26 cells/mm(3) in 2007 to 206 cells/mm(3) at the time of the consultation. We noted after examination clean burgeoning erosion, red in places, pink in other places, with fuzzy boundary, sitting on the glans and extending into the preputial sulcus. Histopathology showed infiltration by sheets of plasma cells with perivascular topography in the dermis. The bacterial cultures and syphilis serology were negative. We noted a good outcome after four weeks of application of 3% oxytetracycline ointment. This observation suggests that the BZ can occur on a HIV infected patient whether he was circumcised or not. Thus, it appears fair to think of BZ faced with a chronic erosion of the glans in HIV infected patient.

Nonspecific genital ulcers.

Recent intervention of nonspecific genital ulcers has added refreshing dimensions to genital ulcer disease. It was considered pertinent to dwell on diverse clinical presentation and diagnostic strategies. It seems to possess spectrum. It includes infective causes, Epstein Bar Virus, tuberculosis, Leishmaniasis, HIV/AIDS related ulcers and amoebiasis. Noninfective causes are immunobullous disorders, aphthosis, Behcet's disease (BD), inflammatory bowel disease, lichen planus and lichen sclerosis et atrophicus, drug reactions, premalignant and malignant conditions, pyoderma gangrenosum, and hidradenitis suppurativa. The diagnostic features and treatment option of each disorder are succinctly outlined for ready reference.

[Balanitis xerotica obliterans with phimosis in elderly patients presenting with difficulty in urination].

Eight elderly patients (average age 76.1±4.3 years) with balanitis xerotica obliterans (BXO) accompanied by phimosis presented with difficulty in urination. Preoperative average international prostate symptom score, average maximum urinary flow rate, and average volume of residual urine were 20.7±6.3 points (n＝8), 5.1±3.6 ml/s (n＝5), and 85.4±77.3 ml (n＝8), respectively. Some of the patient's complaints, such as severe dribbling of urine, urinary stream division, and ballooning of the foreskin, were not included in the items of the major questionnaire on urination. Dorsal incision and circumcision was performed in all patients, and all were pathologically diagnosed with BXO. Meatoplasty was performed in one patient with a meatal stenosis. No coexistence of penile cancer was observed. Statistically significant improvements were observed in subjective and objective findings after treatment. In conclusion, BXO with phimosis in elderly patients should be considered as a cause of lower urinary tract symptoms.

Septic arthritis of the pubic symphysis from Pseudomonas aeruginosa: reconsidering traditional risk factors and symptoms in the elderly patient.

A high-functioning 82-year-old man presented with lower lumbar pain and pubic tenderness. On admission he was afebrile with a normal white count. A grossly elevated C reactive protein was noted. CT scan of the pelvis showed a fluid collection anterior to the pubic symphysis and to the right of the midline measuring 2.0 × 2.2 cm. Pseudomonas aeruginosa was cultured from the fluid collection. The patient had no history of intravenous drug use, pelvic surgeries, malignancies or trauma. We report what we believe is the first documented case of P aeruginosa infection of the pubic symphysis in an elderly patient that did not have any of the traditional risk factors associated with neither P aeruginosa septic arthritis nor infections of the pubic symphysis. Instead, we propose that phimosis with chronic infection of the foreskin and balanitis may have led to septic arthritis.

Incidence of genital infection among patients with type 2 diabetes in the UK General Practice Research Database.

The objective of this population-based study was to evaluate the incidence of vaginitis (females) and balanitis (males) among a cohort of type 2 diabetes patients and compare this risk to patients without diabetes. The study population included 125,237 female patients and 146,603 males identified from GPRD. All patients were followed for 1-year from their study index date for the first record of an infection or a censored event. Among patients with diabetes the incidence of vaginitis was 21.0/1000PY (95% CI 19.8-22.1) with the risk being 1.81 (95% CI 1.64-2.00) greater that patients without diabetes. The incidence of balanitis among diabetes patients was 8.4/1000PY (95% CI 7.8-9.1) with a relative risk of 2.85 (2.39-3.39) compared to patients without diabetes. Additional analyses were performed by HbA1c level. Results from this large population-based study indicate that patients with diabetes are at an increased risk of being diagnosed with infections of the genital tract and patients with poorly controlled diabetes have higher risks.

[Penile squamous cell carcinoma]. / Carcinoma escamoso de pene.

Penile squamous cell carcinoma (SCC) is uncommon in Europe, where it accounts for approximately 0.7% of all malignant tumors in men. The main risk factors are poor hygiene, lack of circumcision, human papillomavirus (HPV) infection, and certain chronic inflammatory skin diseases. HPV infection is detected in 70% to 100% of all penile in situ SCCs and in 30% to 50% of invasive forms of the disease, mainly basaloid and warty SCCs. In situ tumors can be treated conservatively, but close monitoring is essential as they become invasive in between 1% and 30% of cases. The treatment of choice for penile SCC is surgery. Inguinal lymph node irradiation is no longer recommended as a prophylactic measure, and it appears that selective lymph node biopsy might be useful for reducing the morbidity associated with prophylactic inguinal lymph node dissection. Survival is directly related to lymph node involvement. Improving our knowledge of underlying molecular changes and their associated genotypes will open up new therapeutic pathways.

Chronic prostatitis, cystitis, pyelonephritis, and balanoposthitis in a cat.

An adult, intact male domestic shorthair presented for preputial swelling and urinary incontinence. A caudal abdominal mass was palpated. A transabdominal ultrasound examination showed severe prostatomegaly with abnormal tissue extending along the urethra. The cat was euthanized due to the owner's financial constraints and the veterinarians' suspicion of a poor long-term prognosis. Biopsies showed chronic active inflammation of the prostate, bladder, kidneys, ureters, penis, and prepuce most consistent with a chronic infectious process. Reports of feline prostatic disease of any kind are rare. Chronic prostatitis may have a more favorable prognosis than feline prostatic adenocarcinoma, currently the most commonly reported disease of the feline prostate.