How reliable is the genital physical examination in pediatric patients for balanitis xerotica obliterans?

How reliable is the genital physical examination in pediatric patients for balanitis xerotica obliterans?

María P. Rodríguez 1 , Gianluca Gasca-Mayans 2 , Santiago Arango-Pérez 1 , Paula Camargo 1, Valeria Goyeneche 3, Johanna Ovalle-Díaz 4, 5

1 Departamento de Urología, Facultad de Medicina, Hospital Militar Central, Bogotá DC, Colombia; 2 Departamento de Urología, Facultad de Medicina, Hospital Militar Central, Bogotá, Colombia; 3 Departamento de Urología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia; 4 Departamento de Urología, Universidad Militar Nueva Granada, Bogotá, Colombia; 5 Departamento de Urología Pediátrica, Instituto Roosevelt, Bogotá DC, Colombia

*Correspondence: Gianluca Gasca-Mayans. Email: gianlucagascam@gmail.com

Abstract

Objective: The objective is to determine the accuracy of the physical examination for the diagnosis of BXO in the pediatric population, comparing the physical examination with histologic study. Balanitis xerotica obliterans (BXO) is the genital lesion of lichen sclerosus atrophicus, a chronic inflammatory disorder that affects the glans, prepuce, meatus and urethra. Is uncommon in the pediatric population, with compatible findings in histology in 17% of children under 10 years of age and in 53% of children and adolescents. The diagnosis is clinical, with subsequent histological confirmation.

Method: 96 pediatric patients (< 18 years of age) treated with circumcision were evaluated. The database is created with demographic characteristics, surgical indication, finding of BXO in physical examination and the result of pathology. Normal distribution are reported as media and standard deviation, and non-normal variables as median and interquartile range (IQR). Categorical variables are reported as frequency and percentage. To determine the accuracy of the physical examination as a diagnostic test, a ROC curve is used. A p < 0.05 is considered significant.

Results: The median age was 7 years (IQR: 4-10). Of the total number of patients, 30.5% had phimosis and 36.5% had changes due to BXO on physical examination, be rationale for circumcision. The rest underwent elective surgery. The accuracy for the physical examination is 56.3% (95% confidence interval: 0.43-0.7; p = 0.361).

Conclusions: It is important to perform a physical examination on all patients who consult for changes in the foreskin and indication for circumcision. However, is not a reliable diagnostic tool for diagnosing BXO, so all patients with suspected BXO should be taken for histopathological analysis.

Keywords: Balanitis xerotica obliterans. Physical examination. Child.

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