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.

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.

[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 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.

[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.

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.

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.

Tacrolimus therapy for circinate balanitis associated with reactive arthritis.

BACKGROUND: Reactive arthritis is the current name for the clinical triad characterized by arthritis, urethritis, and conjunctivitis, which develops over the course of a month or more. In some patients, this clinical triad is accompanied by circinate balanitis and keratoderma on the palms and soles. Balanitis, in some cases, is refractory to conventional therapy and can be recurrent, becoming a therapeutic challenge. METHODS: A total of 4 clinical cases of male patients, with ages ranging from 21 to 36 years old, presented with arthritis, conjunctivitis, urethritis, and recurrent circinate balanitis, which developed over a period of 1 to 6 months. All patients were treated with corticosteroids and sulfasalazine. In addition, one was treated with ciprofloxacin; however, balanitis was resistant to treatment in 3 patients. RESULTS: As other treatments had failed, topical 0.1% tacrolimus was used, with excellent results, as the balanitis lesions were cleared during the first week of topical therapy. CONCLUSION: We propose the complementary use of topical tacrolimus in cases of reactive arthritis associated with circinate balanitis.

Foreskin length in uncircumcised men is associated with subpreputial wetness.

This study was performed to identify possible factors associated with penile wetness, defined as the observation of a diffuse homogenous film of moisture on the surface of the glans and coronal sulcus, in men attending a sexually transmitted infection clinic. Genital examination was undertaken in 422 uncircumcised men and any degree of subpreputial wetness observed was recorded. The degree of visibility of the urinary meatus on direct inspection was also assessed. Subjects were asked whether they retracted the foreskin while urinating and how long since they had last passed urine. Penile wetness was observed in 13.0% of the men and was more common in those whose foreskin covered the urinary meatus on direct inspection (17.4% vs. 4.9%) and those with balanitis (33.3%). On multivariate analysis, penile wetness was independently associated with balanitis, non-specific urethritis/chlamydia, reporting sex with another man and having a visible urinary meatus on direct inspection. Penile wetness was not associated with retracting the foreskin while passing urine or duration since last passed urine. Men with a foreskin covering the urinary meatus on direct observation should be advised about the benefits of good genital hygiene if penile wetness was observed.

Erythroplasia of Queyrat with Zoon's balanitis: a diagnostic dilemma.

SUMMARY: Chronic erythematous lesions of the penis may result from a variety of underlying causes that form a part of differential diagnosis. They are difficult to diagnose only upon clinical examination and may necessitate performing a biopsy to confirm the diagnosis and also identify the coexisting disease. We report a case of erythroplasia of Queyrat (EQ) with Zoon's balanitis and discuss the classification of the lesion through the analysis of overlapping histological features. A middle-aged uncircumcised man presented with two long-standing erythematous prepucial penile lesions unresponsive to antibiotics. Biopsy performed to establish the diagnosis revealed non-invasive severe dysplastic changes in the epithelium that is typical of EQ. Subepithelial histological features were characteristic of Zoon's balanitis. The extent and nature of inflammatory infiltrate in the dermis described in the literature is quite varied in EQ and in the spectrum of non-cicatricial balanoposthitis. The overlap of histological findings could result in the diagnostic dilemma of a coexistent lesion, as described in this case report.

Erythroplasia of Queyrat of the glans penis on a background of Zoon's plasma cell balanitis.

Erythroplasia of Queyrat of the glans penis developed in a 79-year-old uncircumcised man on a background of biopsy proven Zoon's plasma cell balanitis affecting the same site on the glans. The Zoon's plasma cell balanitis had been treated with topical pimecrolimus for 1 month prior to the development of clinically evident erythroplasia of Queyrat. He was subsequently treated with topical 5-fluorouracil 5% for 2 weeks, which resulted in clinical clearance. He has since been circumcised.

Diagnosis of a preputial cavity abscess with bedside ultrasound in the emergency department.

Bedside ultrasound has become an important diagnostic tool for emergency physicians. Clinical investigators have demonstrated that evaluating soft tissue infections with ultrasound is useful for the detection of subcutaneous abscesses. Bedside ultrasound of a preputial cavity abscess in the Emergency Department has not been previously described in the English medical literature. A preputial cavity abscess, a rare complication of balanoposthitis, is a collection of pus between the foreskin and the distal penis. This case report describes the use of ultrasound to diagnose a penile abscess and reviews the related literature.

Penile carcinoma arising in balanitis xerotica obliterans.

Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.

Syphilis mimicking Reiter's syndrome in an HIV-positive patient.

A 38-year-old man with HIV infection presented with panuveitis, urethritis, and a papulosquamous eruption on his palms and soles. Careful physical and laboratory examination led to the diagnosis of syphilitic keratoderma, uveitis, and balanitis. The patient was successfully treated with penicillin and prednisone therapy. Because the initial presentation was difficult to distinguish from the symptoms of Reiter's syndrome, a high degree of clinical suspicion was required to accurately diagnose syphilis, a curable and potentially fatal disease.

[Urethral meatal stenosis in boys easily overlooked]. / Urethrale-meatusstenose bij jongens gemakkelijk gemist.

Three boys aged 8, 5, 3 and 9 years, respectively, appeared to have urethral meatal stenosis. In the first patient this appeared during a check-up following treatment for balanitis. Patient history revealed that his micturition duration was longer than before. In the second patient, who underwent surgical correction for hypospadia, it was discovered because he took longer to urinate than his brother. In the third patient stenosis was observed during an appointment for a retracted testicle; he had been circumcised earlier for cultural reasons. Meatomy was performed under anaesthesia in all 3 patients, after which the micturition duration and stream velocity were normal. The third patient continued to have an extremely large bladder capacity and residual volume. Meatal stenosis may lead to obstructive uropathy, urinary tract infection and eventually damage to renal parenchyma. Symptomatic presentation can be late. Diagnostic tests include urine analysis and culture, and uroflowmetry. Visual inspection by spreading the meatal dimple to visualise a pinhole urethra cannot be overemphasised.