The obliterating xerotic balanit
The obliterating xerotic balanit (skleroziruyushchiya ) – sclerous - the fibrous and atrophic process with poorly expressed inflammatory component striking a penis head. The obliterating xerotic balanit is characterized by emergence of whitish spots and giperkeratotichesky centers in the field of a head and an internal leaf of extreme flesh, wrinkling of skin owing to what development of a stenosis of extreme flesh, a fimoz, narrowing of the mouth of an urethra is possible. Recognition of a skleroziruyushchy likhen is made on the basis of survey, a biopsy and establishment of the histologic diagnosis. At the obliterating xerotic balanit it is made , the meatotomiya, if necessary - plasticity of an urethra, is appointed local therapy glucocorticoids.
The obliterating xerotic balanit
The obliterating xerotic balanit (skleroziruyushchiya ) can develop at any age: at children, men of middle and advanced age, but meets at patients more often 50 years are more senior. The clinical urology regards the obliterating xerotic balanit as the state contributing to development of cancer of penis.
On histologic signs the obliterating xerotic balanit is similar to scleroatrophic it is deprived also by some local forms of a sklerodermiya. In gynecology the limited sklerodermiya can come to light in external genitals at women in the absence of data for vulvas. These observations allow to unite skin and urogenital skleroziruyushchy processes in one group having the dystrophic nature.
The reasons of the obliterating xerotic balanit
The etiology of a skleroziruyushchy likhen is not clear. It is considered that can lead a wide range of factors to development of the obliterating xerotic balanit – genetic, autoimmune, infectious, mechanical, hormonal.
In dermatology, andrology and gynecology there are observations of family cases sclerous depriving also of a skleroziruyushchy likhen of genitals. The researches conducted in this direction allowed to reveal a number of the genes responsible for development of the inherited obliterating xerotic balanit and degree of its expressiveness.
Data of some scientific researches indicate communication between the obliterating xerotic balanit and autoimmune defeats – vitiligo, psoriasis, a rheumatic polimialgiya, a system red volchanka, diabetes, miksedemy, primary biliarny cirrhosis, an alopetion, etc. Besides, local manifestations of the obliterating xerotic balanit are similar to characteristic changes of fabrics at autoimmune diseases.
The role of virus agents in development of the obliterating xerotic balanit is not excluded: in particular, in fabrics of extreme flesh after performance , causative agents of genital herpes and human papillomavirus infection quite often are found.
In some cases dependence of emergence of the obliterating xerotic balanit on local injuries of skin – a mechanical, chemical or thermal trauma, attritions, chronic irritation by urine, radiation exposure at radiation therapy is traced. A number of researchers note communication sclerous - fibrous changes in area of a head of a penis with the previous surgical trimming of extreme flesh concerning a fimoz.
It is supposed that development of the obliterating xerotic balanit can be connected with age falling of level of testosterone or violation of sensitivity of fabrics to male sex hormones.
Symptoms of the obliterating xerotic balanit
At a skleroziruyushchy likhen the head of a penis and an internal leaf of skin of extreme flesh is surprised – in the beginning there are whitish spots, bubbles with hemorrhagic contents and atrophic sites which then are transformed to sclerous plaques. Further the circular sclerous ring in process of which consolidation removal of a head is at a loss is formed. On this background additional infection can lead to a bacterial inflammation of a head of a penis - to a balanit. In a final stage of the obliterating xerotic balanit with development of a cicatricial fimoz the head absolutely ceases to open.
At the men who earlier transferred trimming, the obliterating xerotic balanit usually begins in a zone of a post-operational skin hem.
Decrease in elasticity of skin of extreme flesh can be followed by its anguishes, especially during sexual intercourse. When scarring an external opening of an urethra and a part of an urethra in the field of a boatshaped pole the complicated urination demanding a natuzhivaniye develops; the stream of urine becomes thin and faltering.
Current of the obliterating xerotic balanit recidivous, long. Sclero-atrophic and giperkeratotichesky processes at the obliterating xerotic balanit not only worsen quality of life, but also can become the reason of recurrent infections of uric ways (an uretrit, cystitis, pyelonephritis), an urolithic disease, a gidronefroz and even to a renal failure.
Diagnostics of the obliterating xerotic balanit
In a complex of diagnostics also PTsR a research of dabs is carried out bacteriological. Final confirmation of existence of the obliterating xerotic balanit is received by means of a biopsy of the changed centers of skin of a penis and urethra and their morphological studying. At a histologic research sites of a follicular giperkeratoz, thinning of a layer of rostkovy epidermis, a homogeneous sclerosis of collagen, reduction or an atrophy of elastichesky fibers, dense limfoplazmotsitarny infiltration come to light. Except verification of the obliterating xerotic balanit, the biopsy allows to exclude cancer of a penis and urethra.
Treatment of the obliterating xerotic balanit
Tactics of treatment of the obliterating xerotic balanit is defined by prevalence of skleroziruyushchy changes.
In an initial I stage of a skleroziruyushchy likhen when only extreme flesh is involved in pathological changes, operation of trimming of extreme flesh () with the subsequent observation is made.
At the II stage of the obliterating xerotic balanit which is characterized by narrowing of an opening of an urethra performance of a meatotomiya – a surgical section of a meatus is required. Further long courses of local therapy by glucocorticoid creams are appointed.
In III and IV stages, involvement of the extreme flesh, a head of the member, an urethra proceeding with total, broad excision of cicatricial fabrics carrying out reconstructive plasticity of an urethra on an extent, then – local glucocorticoid therapy is necessary.
Prevention of the obliterating xerotic balanit
Special prevention of the obliterating xerotic balanit is not developed. It is recommended to avoid a travmatization of genitals and STD, to regularly perform hygienic procedures, to address in due time specialists in an occasion of ekstragenitalny pathology. At detection of any changes in area of a head of a penis consultation of the urologist (andrologist) is necessary for an exception of the obliterating xerotic balanit.
Early excision of the struck fabrics, conservative therapy and observation allow to avoid terrible complications.