Early detection is a key element in the prevention of these complications, and the therapeutic strategy of choice - circumcision - is operationally simple, entails few costs to the National Health System and is extremely effective as a therapeutic and preventive measure. Balanitis xerotica obliterans is an important inflammatory disease of the glans, foreskin and urethral meatus that makes it impossible to retract and is a risk factor for penile carcinoma. The first case of BXO was described by Stuhmer in , since there have been advances in understanding the pathogenesis of the disease, and advances in electron microscopy techniques, which allowed the establishment of the autoimmune nature of this disease.
Its emergent detection and subsequent therapeutic contributes to a lower health expenditure with penile carcinoma. In the article developed by Kizer in , they report an incidence of 0. There are still some risk factors that have a true impact on the development of the disease, and the exact etiology is unknown, however, some theories have been proposed: Autoimmune Theory, Molecular Mechanisms and Genetic Factors: Specific organ antibodies were found in patients with BXO and there is an increased incidence of other AI diseases in these patients diabetes, varicose veins, alopecia.
Retrospective identification based on diagnostic codes in which patients completed a questionnaire were examined and performed analyzes such as blood cell count, glucose, thyroid function tests, auto antibodies and serology for Borrelia and if the histology had not been performed, performed a biopsy of the skin. In general, These patients are not more prone to autoimmune thyroid disease or pernicious anemia, despite a higher incidence of autoimmune phenomena when compared to the normal population [5,6].
An association was established between lichen sclerosus and autoimmune disease in men compared to the general population [6]. Immune nature turns out to be a crucial point in understanding the pathogenesis of this disease.
ECM1 Antibodies on chromosome 1q21 were identified in adult BXO patients, with a reduced expression of this gene in the pediatric population. Further studies are needed to understand the implication of this gene in the pathogenesis of BXO [8,9,10]. In a study developed by Gross, et al, it was found that T lymphocytes involved in SL had T-cell restricted intracellular antigen TIA-H and cytotoxic granzyme B GrB - related to cytotoxic activity in their granules [16]. Micro-RNA, involved in the regulation of the immune response, was also over-regulated [14].
It is highly unlikely that Borrelia burgdorferi plays an etiological role in BXO and hepatitis C has been investigated because of the possible association with LS. Autoimmunity associated with hepatitis C may be responsible for the development of LS in these patients [18,19].
The BXO can present with a white ring in the glans and respective discoloration, secondary phimosis, dysuria and sensation of swelling with the urination.
It may be asymptomatic [13,20]. Symptoms such as non-retractibility of the foreskin, swelling and dysuria are the most frequent. The pathognomonic sign of BXO includes a peri-meatal whitish area associated with an erythema in this area and initially the patient notices some areas of discoloration of the glans or in the external area of the foreskin, accompanied or not by pruritus.
Get a Quick Quote. Toggle navigation. What are the symptoms of BXO? What does BXO look like? How will BXO be diagnosed? Can BXO be cured?
How can BXO be treated? What can I do? Copyright c Thornhill Clinic Limited. All Rights Reserved. Early diagnosis and treatment of BXO are very important in preventing the urological complications of the diseases such as urethral stricture.
Treatment of BXO depends on the anatomic location of the lesions and their extent and severity, together with the rapidity of progression of the disease process.
The treatment may vary from topical corticosteroids, laser vaporization in early cases to meatoplasty and urethroplasty in extensive cases. Topical pharmacotherapy is useful in the early stages to reduce the initial symptoms and slow down the progression, but is not effective in all cases and is not the curative treatment of disease.
Meatal stenosis, phimosis, scar adhesions, fissures, erosions of glans and prepuce and involvement of the urethra are indications for surgical treatment. Topical steroids are the topical forms of corticosteroids.
These have anti-inflammatory properties which are designed to help reduce irritation of the infected area. Glans resurfacing is a procedure that involves removing some skin from the head of the penis. It can be carried out on the area of concern for either benign or cancerous reasons. This will be discussed with you at your consultation. Necessary cookies are absolutely essential for the website to function properly.
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