Das S, Tunuguntla H S
Department of Urology, University of California, Davis, School of Medicine, Sacramento 95817, USA.
World J Urol. 2000 Dec;18(6):382-7. doi: 10.1007/PL00007083.
Balanitis xerotica obliterans (BXO) is a scarcely known disease, wrongly considered rare. With a high degree of suspicion and histologic examination, the condition will prove to be much more frequent than one generally believes. The etiology of the condition is unknown at present. Many cases of BXO occurring after circumcision may be cases of secondary phimosis due to BXO not being recognized at the time of surgery. Most of the cases of BXO are seen in the third to fifth decades of life, even though they may occur at the extremes of age. Biopsy of the lesions is not essential in all cases and is indicated to differentiate from penile cancer and in atypical cases. Early diagnosis and treatment of BXO are very important in preventing the urological complications of the diseases such as urethral stricture. Treatment of BXO depends on the anatomic location of the lesions and their extent and severity, together with the rapidity of progression of the disease process. The treatment may vary from topical corticosteroids, laser vaporization in early cases to meatoplasty and urethroplasty in extensive cases. Topical pharmacotherapy is useful in the early stages to reduce the initial symptoms and slow down the progression, but is not effective in all cases and is not the curative treatment of disease. Meatal stenosis, phimosis, scar adhesions, fissures, erosions of glans and prepuce and involvement of the urethra are indications for surgical treatment. Surgery seems to be the only treatment that can relieve the symptoms of advanced disease. Modified circumcision, with total removal of inner preputial layer, definitively relieves phimosis without any recurrence. Meatotomy will not prevent the recurrence of meatal stenosis. Excision of the scleroatrophic tract and grafting of the glans base, coronal sulcus, and the end of the shaft give a complete relief of pain during erection and intercourse in circumcised patients with balanopreputial adhesions and restore the elasticity of the skin of penile shaft. These procedures have been shown to yield excellent functional results during a follow-up period of up to 4 years. BXO involving anterior urethra can be treated by 2-stage urethroplasty or substitution urethroplasty. The complete excision of the stricture and flap urethroplasty seems to be better than a 2-stage procedure. However, at the present time, it is not possible to say that surgery can completely resolve this chronic and progressive disease. Despite many reports in the literature of cases of BXO associated with squamous cell carcinoma, the etiologic relationship between the two conditions is uncertain.
闭塞性干燥性龟头炎（BXO）是一种鲜为人知的疾病，常被错误地认为很罕见。凭借高度的怀疑和组织学检查，会发现这种疾病的实际发病率比人们普遍认为的要高得多。目前该疾病的病因尚不清楚。许多包皮环切术后出现的BXO病例可能是继发性包茎，原因是手术时未识别出BXO。尽管BXO可发生于任何年龄段，但大多数病例出现在30至50岁之间。并非所有病例都必须进行病变活检，活检主要用于与阴茎癌相鉴别以及诊断不典型病例。BXO的早期诊断和治疗对于预防诸如尿道狭窄等泌尿系统并发症非常重要。BXO的治疗取决于病变的解剖位置、范围和严重程度，以及疾病进展的速度。治疗方法从早期的局部使用皮质类固醇、激光汽化到广泛病变时的尿道口成形术和尿道成形术不等。局部药物治疗在早期有助于减轻初始症状并减缓疾病进展，但并非对所有病例都有效，也不是疾病的根治性治疗方法。尿道口狭窄、包茎、瘢痕粘连、裂隙、龟头和包皮糜烂以及尿道受累是手术治疗的指征。手术似乎是缓解晚期疾病症状的唯一方法。改良包皮环切术，即完全切除包皮内层，可有效缓解包茎且无复发。尿道口切开术无法预防尿道口狭窄的复发。切除硬化萎缩组织并在龟头基部、冠状沟和阴茎体末端进行植皮，可使患有龟头包皮粘连的包皮环切患者在勃起和性交时完全缓解疼痛，并恢复阴茎体皮肤的弹性。这些手术在长达4年的随访期内已显示出极佳的功能效果。累及前尿道的BXO可通过两期尿道成形术或替代尿道成形术进行治疗。完全切除狭窄段并行皮瓣尿道成形术似乎比两期手术效果更好。然而，目前尚不能说手术能完全治愈这种慢性进展性疾病。尽管文献中有许多关于BXO与鳞状细胞癌相关病例的报道，但两者之间的病因关系尚不确定。
