Clinical analysis of children with pathological phimosis treated by circumcision / 中华泌尿外科杂志

ABSTRACT

Objective:To investigate the clinical characteristics of pathological phimosis and analyze the correlation between pathological phimosis and balanitis xerotica obliterans(BXO) in children.Methods:The clinical data of 45 children who underwent circumcision and histopathologic evaluation in our hospital from July 2018 to August 2022 were retrospectively analyzed. According to the results of the pathological examination, lichen sclerosis et atrophicus cases were classified as the BXO group, and other cases were classified as the non-BXO group. The two groups' age, history, and symptoms were recorded and compared. The management of meatal stenosis and the effect of topical steroids were described.Results:There were 33 patients in the BXO group, aged (7.42±2.46)years old, of which 91% (30/33) were 5-11 years old. There were 12 patients in the non-BXO group, aged (10.42±2.88) years old. The difference of age between the two groups was statistically significant ( P< 0.05). But there was no significant difference between the BXO group and non-BXO group in the history of balanoposthitis(28 cases vs. 7 cases), history of foreskin dilated(15 cases vs. 3 cases), frequent urination (18 cases vs. 10 cases), urgent urination(12 cases vs. 4 cases), urination pain(17 cases vs. 3 cases), dysuria(21 cases vs. 5 cases), pruritus(25 cases vs. 7 cases), penile pain(7 cases vs. 1 case), ballooning(7 cases vs. 6 cases), and spraying (14 cases vs. 2 cases)( P > 0.05). All 8 cases of meatal stenosis were in the BXO group. Three cases underwent meatal dilatation and indwelling catheter was left for 5-10 days, and topical steroid was used on the third day after surgery. The remaining cases were treated with topical steroids after a pathological diagnosis of BXO. Among the 4 cases with partial urethral meatus involvement, 3 had good results after treatment, and 1 had no significant improvement and underwent meatal dilatation twice later. In 1 case, meatal stenosis was found two weeks after surgery, but no meatal abnormality was found during operation. All patients recovered smoothly during a median follow-up of 12.2 (5.4, 21.8) months. Conclusions:BXO is the main cause of pathologic phimosis in boys, and the diagnosis is based on histopathology. The main complication of BXO is meatal stenosis, which should be detected as early as possible and treated in time.