Balanitis xerotica obliterans is also known as lichen sclerosus. This is a process that has a sclerotic-fibrous nature and is characterized by atrophy that accompanies certain stages of its development. The inflammatory component is weakly expressed. It affects mainly the head of the penis.
Balanitis xerotica obliterans can occur at any age, as it occurs in children, adolescents, middle-aged and elderly men. However, it is most typical for patients at a more adult age – about 50 years.
This disease is regarded by modern urology as capable of leading to the development of penile cancer. According to its histological symptoms, balanitis xerotica obliterans is most similar to lichen sclerosus. It also coincides with some manifestations of scleroderma (its local forms). This allows you to combine the disease into a group that includes diseases of a dystrophic nature.
Balanitis xerotica obliterans is accompanied by the appearance of whitish spots in the head area, hyperkeratotic foci. The inner leaf of the foreskin is also affected. Due to the fact that the symptoms include wrinkling of the skin, the development of phimosis, narrowing of the urethra, stenosis of the foreskin is not excluded. Lichen sclerosus is diagnosed after a clinical examination, biopsy and histological examination of the biopsy. In order to treat balanitis xerotica obliterans, a wide range of medical techniques are prescribed. Use meatotomy, circumcision. If necessary, plastic surgery on the urethra, or local drug therapy with steroids, is performed.
Symptoms of balanitis xerotica obliterans
Symptoms of the disease include external manifestations that appear on the penis and the inner leaf of the foreskin. Here, whitish spots, blisters with hemorrhagic fluid, areas of atrophy are revealed. The affected tissue areas then turn into sclerotic plaques. After that, over time, a sclerotic ring is formed. The removal of the head will subsequently be difficult due to the compaction of the sclerotic ring. Possible secondary infection of the penis at this stage of the development of the disease – balanitis. The final stage of development of sclerosing lichen is manifested in the impossibility of opening the head and the final development of cicatricial phimosis.
The circumcision procedure that men endure can lead to the development of the disease, then this occurs at the stage of the skin scar formed after the operation.
Since the elasticity of the skin of the penis decreases, ruptures of the foreskin often appear, which most often occur during sexual intercourse. If the external opening is scarred, then the opening of the urethra, as well as parts of the urethra, make the passage of urine difficult. The jet becomes thin, and the process itself requires tension.
The course of balanitis xerotica obliterans has a recurrent character. A long process is characterized by sclero-atrophic and hyperkeratotic manifestations, which can cause secondary, recurrent urinary tract lesions. They also impair the patient’s quality of life. The consequence of such manifestations may be urethritis, pyelonephritis, cystitis, hydronephrosis, renal failure.
Causes of balanitis xerotica obliterans
Modern urology cannot fully explain the reasons why balanitis xerotica obliterans appears and develops. Basically, experts agree that the etiology of the disease includes a wide range of diseases of various nature: mechanical, genetic, hormonal, infectious, autoimmune.
Andrologists and dermatologists record cases when balanitis xerotica obliterans becomes a disease tolerated by all family members. A separate form of this disease, characteristic of women, is also noted by gynecologists. Studies directed at such cases of lichen sclerosus have shown the existence of a number of genes responsible for the fact that balanitis xerotica obliterans develops in a hereditary manner and has a certain degree of severity.
Scientific research has also led to the fact that some connection was found between sclerosing lichen and autoimmune diseases such as vitiligo, psoriasis, lupus, diabetes, alopecia and others. It is also noted that the characteristic local symptoms of the disease are similar to tissue lesions in autoimmune diseases.
However, according to researchers, balanitis xerotica obliterans can also develop under the influence of viruses. The causative agents of herpes or HPV have been repeatedly detected after the circumcision procedure.
Local damage to the skin can also cause the development of the disease. This dependence can be traced in a number of cases. So mechanical, thermal or chemical trauma, skin irritation, radiation exposure can affect the course of the disease. In addition, there is a connection between sclerotic-fibrous changes in the tissues of the penis and the operation performed on it, due to phimosis.
The age-related drop in testosterone levels, as well as the phenomenon of a violation of the sensitivity of the male body to sex hormones, can serve as a reason for the development of the disease.
Diagnosis of balanitis xerotica obliterans
Bacterial, fungal balanoposthitis, various herpetic and chlamydial infections, leukoplakia, kraurosis, acquired phimosis have similar symptoms. Therefore, differential diagnosis with these diseases is carried out.
A smear test is used to diagnose lichen sclerosus. These analyzes are subject to bacteriological and PCR study. A biopsy of the affected areas of the penis and urethra is also performed, after which the biopsy is morphologically examined. Only after such an analysis can a final diagnosis be made.
Histological analysis, prescribed for suspected balanitis xerotica obliterans, shows the presence of areas of follicular hyperkeratosis, homogeneous collagen sclerosis, atrophy of elastic fibers, and thinning of the germinal epidermis layer. A biopsy has another advantage: it rules out or confirms cancer of the penis or urethra.
Balanitis xerotica obliterans treatment
The prevalence of changes in the tissues of the penis that accompanies balanitis xerotica obliterans determines how therapy is administered.
• Stage I is the initial stage. Involvement of the foreskin in the development of the disease. Only this area is susceptible to pathology. For treatment, circumcision is used – circumcision, after which you should be observed by a doctor.
• Stage II – narrowing of the opening of the urethra. At this stage, it is necessary to perform a meatotomy – dissection of the meatus (external opening of the urethra). After surgery, drug therapy with dermovate, diprospan, or other glucocorticoid creams follows.
• III, IV stage – complete involvement of the foreskin, head, urethra of the penis. It is necessary to prescribe the excision of scar tissue. Reconstructive plastic surgery on the urethra is also performed. Steroid treatment is used.
Sclero-atrophic and hyperkeratotic processes with balanitis xerotica obliterans not only worsen the quality of life, but can also cause recurrent urinary tract infections (urethritis, cystitis, pyelonephritis), urolithiasis, hydronephrosis, and even renal failure.
Forecast and prevention
With timely treatment, the prognosis is favorable, urination disorders are observed in the later stages, and the likelihood of developing penile cancer increases. Special prophylaxis has not been developed. It is recommended to avoid traumatizing the genital organs and STDs, regularly perform hygiene procedures, and contact specialists in a timely manner regarding extragenital pathology. If any changes are found in the area of the glans penis, consultation with an andrologist is necessary. Early excision of the affected tissues, conservative therapy and observation make it possible to avoid formidable complications.