Penoscrotal Pathology
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
Associated complications:Lichen sclerosus (LS): ~5% of cases may progress to penile cancer, but it has a long latency period (~17 years). Phimosis increases the odd ratio of developing cancer (OR 4.9–37.2). Neonatal circumcision is protective (OR 0.33). LS is associated with well-differentiated and keratinising squamous cell carcinoma subtypes.Balanitis (inflammation of the glans penis) and posthitis (inflammation of the prepuce, Figure 21.1c) − inflammatory secretions and pus are trapped under the foreskin, not in the foreskin by the phimotic band.Treatment: improve hygiene. Antibiotics/ anti-fungals dependent on infective cause. Circumcision for recurrent infectionsOther causes of balanitis include local irritants, Candida fungal infection, psoriasis, eczema, sexually transmitted infection (STI, see below), Zoon’s.Paraphimosis (Figure 21.1d): prepuce gets stuck in the retracted state → venous congestion → oedema → swelling → arterial occlusion and necrosisTreatment: manual reduction but if unsuccessful → surgical reduction, dorsal slit +/- circumcision
Genital
Keith Hopcroft, Vincent Forte in Symptom Sorter, 2020
SMALL PRINT: IVU, cystoscopy, terminal stream urine. Urinalysis: may reveal proteinuria, haematuria, pus cells and nitrites in the presence of infection; haematuria alone with a stone. Will also reveal glycosuria in the previously undiagnosed diabetic (may present with candidal balanitis).MSU (for MC&S): to establish pathogen in UTI (may also reveal infective agent in prostatitis).Swabs for microbiology: urethral swab if urethritis likely (best performed at GUM clinic). In balanitis with discharge, a swab may help guide treatment.FBC and ESR/CRP: WCC and ESR/CRP raised in significant infection and inflammation (e.g. prostatitis or prostatic abscess). ESR/CRP may be raised in malignancy.PSA: consider this test if carcinoma of the prostate a possibility.IVU more useful than ultrasound to investigate the urinary tract if stone or carcinoma suspected, or if chronic UTI suspected.Terminal stream urine: for schistosomiasis.Cystoscopy: may be required in secondary care to confirm and treat stone or tumour.
The red glans penis
Manu Shah, Ariyaratne de Silva in The Male Genitalia, 2018
The red glans penis is a common clinical problem, especially in uncircumcised men. The term balanitis is used to describe inflammation of the glans penis whilst balanoposthitis refers to inflammation of both the glans and the foreskin. Balanitis is a symptom, not a diagnosis, and causes for penile inflammation should be sought. Perhaps the most common problem is poor personal hygiene. This predisposes to irritation and infection under the foreskin. This may result in phimosis or a penile discharge. In the dermatology clinic the commonest causes of balanitis are inflammatory dermatoses. Sexual health physicians may see more cases of infective balanitis.
Penile Sparing Techniques For Penile Cancer
Published in Postgraduate Medicine, 2020
Andrew Fang, James Ferguson
Malignant penile lesions include basal cell carcinoma, melanoma, sarcomas, adenocarcinoma, and metastatic lesions; however, squamous cell carcinoma is the most common histologic subtype and is the focus of this review. Penile cancers are predominantly distal with 58% of penile cancer cases occurring on the glans, 16% on the foreskin, 9% on both the glans and foreskin, 2% on the shaft, 1% on the glans and shaft with the remaining 13% at unspecified sites [9]. Several risk factors have been associated with penile cancer. Newborn circumcision is associated with an estimated 22-fold reduction in the lifetime development of penile cancer [10]. Interestingly, adult circumcision does not offer the same prophylactic benefits [11]. Circumcision is thought to eliminate the closed glanular environment that leads to chronic inflammatory states including phimosis, balanitis, and smegma retention. Inflammatory conditions and carcinogenic exposures including lichen sclerosis/balanitis xerotica obliterans, penile trauma, psoralen UV-A photochemotherapy, and tobacco use are recognized as significant risk factors to the development of penile cancer [12,13]. HPV has garnered increased attention due to its role in the development of other malignancies. While there are several HPV subtypes, serotypes 16 and 18 are associated with a higher risk of malignancy [14]. HPV is associated with 22–66% of all penile cancers with the basaloid and warty subtypes showing the highest association [15,16]
An evaluation of the pharmacotherapeutic options for the treatment of adult phimosis. A systematic review of the evidence
Published in Expert Opinion on Pharmacotherapy, 2022
Anna Lygas, Hrishikesh Bhaskar Joshi
The differential diagnosis of foreskin pathologies in male patients, that can present as or with phimosis, include sexually transmitted diseases and skin problems such as lichen planus, psoriasis, eczema, squamous skin carcinoma, and zoon balanitis [14]. Despite clear morbidity and mortality associated with LS the number of studies focusing on the adult male population, with proven LS, are relatively small and the evidence behind the treatments, especially pharmacological treatments, in adults remains unclear. It is likely that pharmacological treatments are followed more commonly in the men who avoid surgical treatment such as circumcision. The objective of this study was to evaluate pharmacotherapeutic options in adult population with phimosis or LS and report on their outcomes. It is expected that the review will highlight the areas for the future research.
CARMIL2 Immunodeficiency with Epstein Barr Virus Associated Smooth Muscle Tumor (EBV-SMT). Report of a Case with Comprehensive Review of Literature
Published in Fetal and Pediatric Pathology, 2022
Mukul Vij, Meena Sivasankaran, Dhaarani Jayaraman, Srinivas Sankaranarayanan, Vimal Kumar, Deenadayalan Munirathnam, Julius Scott
A 5-year-old boy presented with recurrent abdominal pain for the past one year. Ultrasound (USG) of the abdomen revealed a fusiform dilatation of common bile duct suggestive of forme fruste choledochal cyst and two small hypoechoic lesions in the liver, the larger measuring 1.7 cm., with enlarged periportal lymph nodes. He underwent excision of choledochal cyst with Roux-en-Y hepaticojejunostomy and periportal lymph node sampling demonstrated reactive lymphoid hyperplasia. No biopsy from the liver lesion was performed. Recurrent abdominal pain continued. His history included recurrent respiratory infections, recurrent lower limb ecthyma associated with inguinal lymphadenopathy responsive to antibiotics, and balanitis xerotica. HIV serology was negative. T and B lymphocyte subset analysis showed below normal CD4 counts with upregulation of CD 8 [CD3-3215 cells/ul (reference range: 1424–2662) and CD3-2005 cells/ul (reference range: 602–1203), with reduced CD4-980cells/ul (reference range: 1000–1931) and NK cells (116 cells/ul) (reference range: 130–720). Immunoglobulin profiles showed IgG 1750 mg/dl (reference range: 700–1600), IgA-444 mg/dl (reference range: 60–400), and IgM-528mg/dl (reference range: 60–300). Clinical exome sequencing revealed heterozygous nonsynonymous variation (c.1736G > A) located on exon 16 of the NFKB1 gene at a depth of 134X. Sequencing of the asymptomatic mother revealed homozygous mutation at c.1736G > A (p.Arg579Lys) position located on exon 16 of the NFKB1 gene, classified as a variant of uncertain significance. There was no family history of consanguinity.
Related Knowledge Centers
- Ammonia
- Dermatitis
- Diaper
- Glans Penis
- Inflammation
- Paraphimosis
- Phimosis
- Foreskin
- Acorn
- Urinary Meatus