Diabetes and Tight Foreskin

A comprehensive study conducted in the United Kingdom focused on a group of 100 men ranging in age from 17 to 82 years, with an average age of 38 years. The study aimed to investigate the prevalence and characteristics of phimosis, a condition characterized by the tight foreskin, in this population.

The researchers found that among the participants, 31% had a lifelong history of phimosis, meaning they had experienced this condition since birth or early childhood, while the remaining 69% had acquired phimosis, meaning it developed later in life. It is worth noting that the prevalence of acquired phimosis was significantly higher than that of lifelong phimosis.

Additionally, the study revealed that among the men with acquired phimosis, 32% had a medical history of diabetes. This finding indicated a notable association between acquired phimosis and diabetes. In fact, the data showed that men with a history of diabetes were 6.7 times more likely to develop phimosis compared to those without diabetes.

Moreover, the researchers observed that phimosis could potentially serve as a warning sign for diabetes. Surprisingly, among the men who had acquired phimosis but had no previous history of glucose metabolism disorders or diabetes, 12% were found to have diabetes (8%) or impaired fasting glycemia (4%). This prevalence of diabetes was higher than the national average in the UK, which stood at 3.6% during the study period. These findings suggest that the presence of phimosis in some individuals may indicate an increased likelihood of diabetes or related metabolic disorders.

It is important to note that balanitis, a condition characterized by inflammation of the glans penis, is commonly associated with diabetes. The recurrent infections and scarring resulting from balanitis are likely contributing factors to the development of phimosis in individuals with diabetes.

In summary, this UK-based study shed light on the prevalence and implications of phimosis in a diverse group of men. The findings indicate that acquired phimosis is more common than lifelong phimosis and that there is a significant association between phimosis and diabetes. Furthermore, the study suggests that phimosis could potentially serve as an indicator of diabetes, as a higher proportion of men with phimosis were found to have diabetes or impaired fasting glycemia compared to the general population. The study also emphasized the relationship between balanitis and phimosis in individuals with diabetes, highlighting the role of recurrent infections and scarring in the development of this condition.

We provide is comprehensive treatment of tight foreskin (Phimosis) and also we treat with tight foreskin with diabetics. In some patients , BXO or lichen sclerosis is also present which required treatment in the form of topical steroids, antibiotics, anti fugal and circumcision in most of the advanced BXO.

Reference:

SJ Bromage, A Crump, I Pearce

Phimosis as a presenting feature of diabetes

BJU Int, 101 (2007), pp. 338-340

Balanoposthitis Or Balanitis

Balanoposthitis and Balanitis for adults and Children

Balanoposthitis is an inflammatory condition that affects both the glans penis (balanitis) and prepuce (foreskin). The condition is most common in uncircumcised males and is characterized by symptoms such as penile pain, pruritus (itching), discharge, erythema (redness), rash, or inconsolable crying in children.

There are several possible causes of balanoposthitis, including poor hygiene, infections (such as candidal, bacterial, or viral infections), inflammatory skin diseases, irritants, trauma, and cancer. Poor hygiene is the most common cause of nonspecific balanoposthitis. Infections such as candidal infections are common in children. They can be associated with diaper rash, while other infectious causes include aerobic bacteria such as Staphylococcus aureus and Group A Streptococcus, anaerobic bacteria, and viruses such as human papillomavirus.

The prevalence of balanoposthitis is between 12% to 20% in males of all ages. Paediatric patients commonly present around ages 2 to 5 years, likely due to physiologic phimosis and hygiene habits. In adults, uncircumcised males with diabetes mellitus are at the highest risk, with a prevalence of around 35%. Circumcision has been shown to decrease the prevalence of inflammatory conditions of the glans penis by 68%.

According to the American Urological Association, balanitis affects up to 11% of men and can occur at any age, but it is more common in older men and those who are uncircumcised.

Pathophysiologic processes can vary widely depending on the aetiology of balanoposthitis. Most cases commence with moisture such as urine, sweat, or smegma (physiologic secretion from genital sebaceous glands) becoming trapped within the preputial space, creating a nidus for bacteria and fungi. Balanoposthitis can also be commonly provoked by irritants and allergens, causing non-specific inflammation leading to erythema and pruritis.

A thorough history and physical exam are sufficient in most cases of balanoposthitis for diagnosis and establishing a course of treatment. Your doctor may also recommend testing for sexually transmitted infections (STIs) if there is a suspicion of infection.

if you experience persistent or severe symptoms of balanitis or balanoposthitis, or as untreated cases can lead to complications such as scarring or phimosis. The diagnosis of BXO is typically made based on the appearance of the affected skin. Still, a circumcision and biopsy may be necessary to confirm the diagnosis and treatment of the phimosis.

Treatment may include hygiene improvements, topical or systemic antimicrobial agents, anti-inflammatory agents, topical steroids and circumcision in severe cases. Establishing the underlying cause of balanoposthitis is vital to guide appropriate treatment. Additionally, practising good hygiene habits and using protection during sexual activity can help prevent the development of balanitis.

Circumcision is recommended in phimosis and scaring due to BXO

Treatment options for BXO include topical and intralesional steroids, circumcision with frenuloplasty, and various surgical techniques for more severe cases.

Regular follow-up care is important to monitor changes in the affected areas that may indicate malignancy.

Sources:

1. American Urological Association. Balanitis. https://www.auanet.org/education/auauniversity/medical-student-education/conditions-education/balanitis

2. Mayo Clinic. Balanitis. https://www.mayoclinic.org/diseases-conditions/balanitis/symptoms-causes/syc-20354817

3. NHS. Balanitis. https://www.nhs.uk/conditions/balanitis/

4. Harvard Health Publishing. Balanitis. https://www.health.harvard.edu/a_to_z/balanitis-a-to-z

The rate of lichen sclerosus (BXO) was significantly higher among male patients with acquired than congenital phimosis

Balanitis Xerotica Obliterans (BXO) in acquired Phimosis in male patients

BXO is thin white dry patches that appear on the foreskin. It can be troublesome if this is not treated. This causes tight foreskin in children and adults. This is also known as lichen sclerosus

If any male patients who has tight foreskin recently , we must exclude BXO phimosis. Literature showed that it is more likely to due to BXO

Following advice will be given

1. Topical steroids have been used. Topical steroids can offer a reliable option only in the management of mild or early BXO limited to the prepuce in boys with minimal scar formation.

2. Circumcision with frenuloplasty in adults and children with BXO may be required if there is no improvement in the tight foreskin with steroids

3. Further treatment, or treatment of circumcised patients, is more challenging. Topical steroids will require in patients after circumcision who has BXO on glans (head) penis 

4. Steroids injection provides efficacious management for urinary stricture disease in patients with biopsy ­proven BXO before invasive surgery.