Guo Xiang,Ma Hui,Wang Jun,et al.Clinical characteristics of urinary retention in children with dry occlusive balanitis[J].Journal of Clinical Pediatric Surgery,2025,(04):377-380.[doi:10.3760/cma.j.cn101785-202405039-014]
Clinical characteristics of urinary retention in children with dry occlusive balanitis
- Keywords:
- Balanitis Xerotica Obliterans; Pathological Status; Signs and Symptoms; Circumcision; Male; Child
- Abstract:
- Objective To explore the clinical characteristics of balanitis xerotica obliterans (BXO) complicated with urinary retention undergoing emergency circumcision in children.Methods From January 2019 to September 2023,retrospective analysis was conducted for the relevant clinical data of 23 children undergoing emergency circumcision for BXO complicated with urinary retention.Onset age,duration of indwelling catheter,previous medical history,perioperative penile lesions and postoperative urethral stricture were recorded.Results Mean onset age was 8.5(7-10) years.Twenty cases (87%) had a previous history of recurrent redness,swelling or itching of foreskin within the last month,2 cases (9%) had a history of foreskin trauma and 1 case (4%) had poor penile exposure.All attempted catheterizations failed (100%).Preoperative swelling of foreskin opening was associated with scar narrowing and inability of exposing urethral opening.During operation,white pseudomembrane attachment was observed on inner plate of foreskin and glans penis.Moss-like lesions infiltrated glans penis,frenulum and external urethral opening.Frenulum of foreskin contracted and external urethral opening narrowed.After 3-month follow-ups,21 cases (91%) developed concurrent urethral meatus stenosis,phimosis and penile sclerosis.Conclusions Short-term recurrent infection of foreskin is a major risk factor for BXO complicated with acute urinary retention.BXO occurs predominantly in children aged (7-10) year.Direct emergency surgery is recommended.BXO children complicated with urinary retention tend to enter advanced clinical stage and their lesions have infiltrated glans penis and urethral meatus.The postoperative incidence of urethral meatus stenosis has remained high.
References:
[1] Russo T,Currò M,Ferlazzo N,et al.Stable ozonides with vitamin E acetate versus corticosteroid in the treatment of lichen sclerosus in foreskin:evaluation of effects on inflammation[J].Urol Int,2019,103(4):459-465.DOI:10.1159/000499846.
[2] Morrel B,van Eersel R,Burger CW,et al.The long-term clinical consequences of juvenile vulvar lichen sclerosus:a systematic review[J].J Am Acad Dermatol,2020,82(2):469-477.DOI:10.1016/j.jaad.2019.08.030.
[3] 赵冬艳,唐达星,徐珊,等.干燥性闭塞性龟头炎儿童时期发病特点分析[J].临床小儿外科杂志,2018,17(1):34-37.DOI:10.3969/j.issn.1671-6353.2018.01.009. Zhao DY,Tang DX,Xu S,et al.Onset features of balanitis xerotica obliterans in children[J].DOI:10.3969/j.issn.1671-6353.2018.01.009.
[4] 张镟,邓涛,张九鸿,等.儿童干燥闭塞性阴茎头炎8例及文献复习[J].临床小儿外科杂志,2018,17(7):514-518.DOI:10.3969/j.issn.1671-6353.2018.07.009. Zhang X,Deng T,Zhang JH,et al.Balanitis xerotica obliterans in boys:a report of 8 cases with a literature review[J].J Clin Ped Sur,2018,17(7):514-518.DOI:10.3969/j.issn.1671-6353.2018.07.009.
[5] Celis S,Reed F,Murphy F,et al.Balanitis xerotica obliterans in children and adolescents:a literature review and clinical series[J].J Pediatr Urol,2014,10(1):34-39.DOI:10.1016/j.jpurol.2013.09.027.
[6] Tong LX,Sun GS,Teng JMC.Pediatric lichen sclerosus:a review of the epidemiology and treatment options[J].Pediatr Dermatol,2015,32(5):593-599.DOI:10.1111/pde.12615.
[7] Charlton OA,Smith SD.Balanitis xerotica obliterans:a review of diagnosis and management[J].Int J Dermatol,2019,58(7):777-781.DOI:10.1111/ijd.14236.
[8] 孙中文,徐青雨,马志.男童外生殖器萎缩性硬化性苔藓的治疗进展[J].临床小儿外科杂志,2022,21(11):1086-1089.DOI:10.3760/cma.j.cn101785-202104003-016. Sun ZW,Xu QY,Ma Z.Recent therapeutic advances of genitourinary lichen sclerosus in boys[J].J Clin Ped Sur,2022,21(11):1086-1089.DOI:10.3760/cma.j.cn101785-202104003-016.
[9] Becker K,Meissner V,Farwick W,et al.Lichen sclerosus and atopy in boys:coincidence or correlation?[J].Br J Dermatol,2013,168(2):362-366.DOI:10.1111/j.1365-2133.2012.11201.x.
[10] Pilatz A,Altinkilic B,Schormann E,et al.Congenital phimosis in patients with and without lichen sclerosus:distinct expression patterns of tissue remodeling associated genes[J].J Urol,2013,189(1):268-274.DOI:10.1016/j.juro.2012.09.010.
[11] Chung ASJ,Suarez OA.Current treatment of lichen sclerosus and stricture[J].World J Urol,2020,38(12):3061-3067.DOI:10.1007/s00345-019-03030-z.
[12] Nguyen ATM,Holland AJA.Balanitis xerotica obliterans:an update for clinicians[J].Eur J Pediatr,2020,179(1):9-16.DOI:10.1007/s00431-019-03516-3.
[13] Promm M,R?sch WH,Kirtschig G.Lichen sclerosus in children[J].Urologe A,2020,59(3):271-277.DOI:10.1007/s00120-020-01140-w.
[14] Pradhan A,Patel R,Said AJ,et al.10 years’ experience in balanitis xerotica obliterans:a single-institution study[J].Eur J Pediatr Surg,2019,29(3):302-306.DOI:10.1055/s-0038-1668562.
Memo
收稿日期:2024-5-17。
通讯作者:马慧,Email:gz582008@163.com