(1)
Pediatric Surgery, Al Azher University, Cairo, Egypt
Abstract
Balanitis Xerotica Obliterans (BXO) is a chronic atrophic mucocutaneous disorder with unknown cause, affecting the epidermis and dermal connective tissue that most commonly involves the genital and perianal skin of both males and females. BXO may affect the glans and the meatus. In its most severe form, involvement of the prepuce obliterates the preputial sac with dense adhesions, and the urethra may be affected.
Zoon balanophostitis is a benign disease of external genitals, and considered as a variant of BXO, and very rarely affecting children, it is more often seen in elderly males than females, characterized by a solitary red-orange plaque of the glans and prepuce.
Keywords
Balanitis Xerotica Obliterans (BXO)Lichen sclerosis et atrophicusZoon balanophostitisLeukoplakia of the penisNomenclature
Balanitis Xerotica Obliterans (BXO), lichen sclerosis et atrophicus.
37.1 Historical Background
Leukoplakia of the penis with sclerotic, atrophic dermatoses of the glans and prepuce was described for the first time by Perrin at 1892 [1], but Stühmer in 1928 [2], published the earlier reports of 5 cases with an atrophic, shrinking process involving the glans and prepuce and frequently leading to urethral stenosis, and he is the one who used the term Balanitis Xerotica Obliterans.
Definition
It is a chronic atrophic mucocutaneous disorder with no known cause, affecting the epidermis and dermal connective tissue that most commonly involves the genital and perianal skin of both males and females. BXO may affect the glans and the meatus. In its most severe form, involvement of the prepuce obliterates the preputial sac with dense adhesions, and the urethra may be affected.
37.2 Incidence
BXO is rare under the age of 5 years old, with a peak incidence in boys aged 9–11 years old (76 %), and is estimated to have affected 0.6 % of boys by their 15th birthday. There is a bimodal age incidence with peaks in young boys and in adult men late in the fourth decade.
It seems that the true incidence of BXO is not accurately reported as recently many cases recorded after hypospadias repair [3]. The epidemiology may vary between countries and racial groups because BXO is principally a disease of the uncircumcised although it can persist or recur after circumcision [4] (Fig 37.1).
Fig. 37.1
Balanitis Xerotica Obliterans in a 5 years old boy
37.3 Pathology
True pathological phimosis with scarring of the preputial orifice is caused by chronic cicatrizing skin condition of unknown etiology. The disease process is histologically identical to lichen sclerosis as it affects the prepuce, glans, and occasionally the urethra. Histological findings characterized by hyperkeratosis with follicular plugging, atrophy of the stratum spinosum and stratum malpighi with hydropic degeneration of basal cells, lymphedema, hyalinosis, homogenization of collagen in the dermis, and an associated band-like chronic inflammatory cell infiltrate. Glanular involvement occurs in 49 % of cases, although the meatus is affected in only a small proportion (Fig 37.2.).
