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]
儿童干燥性闭塞性龟头炎并发尿潴留的临床特点与疗效分析
- Title:
- Clinical characteristics of urinary retention in children with dry occlusive balanitis
- Keywords:
- Balanitis Xerotica Obliterans; Pathological Status; Signs and Symptoms; Circumcision; Male; Child
- 摘要:
- 目的 探讨干燥性闭塞性龟头炎(balanitis xerotica obliterans,BXO)并发尿潴留急诊入院行包皮环切术患儿的临床特点与治疗经验。方法 回顾性分析 2019年 1月至 2023年 9月华中科技大学同济医学院附属武汉儿童医院泌尿外科收治的23例因干燥性闭塞性龟头炎并发尿潴留而急诊行包皮环切术患儿的临床资料,收集患儿发病年龄、既往史、治疗情况、术前病变、术中所见以及术后随访情况等。结果 23例患儿年龄7~10岁,平均年龄8.5岁。其中20例(87%)近1个月内有反复包皮红肿或瘙痒病史,2例(9%)有包皮外伤史,1例(4%)存在阴茎显露不良。23例均因试行导尿失败而行包皮环切术。术前均见包皮口肿胀伴瘢痕缩窄,尿道外口不能显露。术中均见包皮内板及阴茎头有白色伪膜附着,苔藓样病变侵犯阴茎头及系带,同时累及尿道外口,包皮系带挛缩伴尿道外口狭窄。术后随访3个月,21例(91%)存在尿道外口狭窄,包皮内板及龟头硬化;2例无尿道狭窄发生,包皮及龟头皮肤损害消失。结论 儿童BXO好发于7~10岁,短期内反复包皮感染是儿童BXO并发尿潴留的主要危险因素,建议急诊行包皮环切术,不推荐尝试留置尿管。儿童BXO并发尿潴留多提示病变已侵犯尿道外口,术后尿道外口狭窄的发生率较高。
- 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.
参考文献/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.
相似文献/References:
[1]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(01):34.
Zhao Dongyan,Tang Daxing,Xu Shan,et al.The incidence of balanitis xerotica obliterans in children.[J].Journal of Clinical Pediatric Surgery,2018,17(04):34.
[2]刘明璐,杨寅愉,张蔚,等.先天性心脏病手术后残余解剖畸形患者体外膜肺氧合支持的效果分析[J].临床小儿外科杂志,2021,20(06):518.[doi:10.12260/lcxewkzz.2021.06.004]
Liu Minglu,Yang Yinyu,Zhang Wei,et al.ECMO in patients with residual lesions after cardiac surgery[J].Journal of Clinical Pediatric Surgery,2021,20(04):518.[doi:10.12260/lcxewkzz.2021.06.004]
[3]陈巍,刘璐,刘婷婷,等.免疫妥协儿童急性阑尾炎的临床特征及诊治探讨[J].临床小儿外科杂志,2025,(02):159.[doi:10.3760/cma.j.cn101785-202112055-010]
Chen Wei,Liu Lu,Liu Tingting,et al.Clinical features,diagnoses and treatments of acute appendicitis in immunocompromised children[J].Journal of Clinical Pediatric Surgery,2025,(04):159.[doi:10.3760/cma.j.cn101785-202112055-010]
[4]吴莹,任红霞,吴晓霞,等.胎粪性腹膜炎产前产后一体化诊治的结局探讨[J].临床小儿外科杂志,2025,(04):351.[doi:10.3760/cma.j.cn101785-202409065-009]
Wu Ying,Ren Hongxi,Wu Xiaoxia,et al.Outcomes of integrated prenatal diagnosis and postpartum treatment of meconium peritonitis[J].Journal of Clinical Pediatric Surgery,2025,(04):351.[doi:10.3760/cma.j.cn101785-202409065-009]
[5]李司琪,刘俊,王观筠,等.神经母细胞性肿瘤相关综合征的临床表现及发病机制[J].临床小儿外科杂志,2025,(04):396.[doi:10.3760/cma.j.cn101785-232307003-019]
Li Siqi,Liu Jun,Wang Guanyun,et al.Clinical manifestations and pathogenesis of syndromes associated with neuroblastic tumors[J].Journal of Clinical Pediatric Surgery,2025,(04):396.[doi:10.3760/cma.j.cn101785-232307003-019]
备注/Memo
收稿日期:2024-5-17。
通讯作者:马慧,Email:gz582008@163.com