Dystrophic diseases of the penile skin represent a heterogeneous group of conditions requiring different therapeutic approaches. These processes may result in irreversible changes in the genital skin that adversely affect patients quality of life. This publication presents a series of clinical cases in which Flamena gel coating was used as part of combination therapy. In a small group of patients with penile lichen sclerosus, steroid balanoposthitis, and plasma cell balanitis, the liposomal antioxidant-phospholipid complex Flamena demonstrated beneficial therapeutic effects.

Intravesical Bacillus Calmette-Guérin (BCG) related complications are known to present in a myriad of forms. We report an unusual presentation of subcutaneous penile nodules without balanitis or glans ulceration with concomitant granulomatous prostatitis following the induction course of BCG for bladder cancer. Levels of evidence are not applicable.

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a rare penile condition usually seen in elderly uncircumcised men. We report a case of PKMB in a 41-year-old circumcised male presenting with a hyperkeratotic plaque on the glans penis. Histopathology showed features of PKMB with mild cellular atypia. The patient refused surgery and was treated successfully with topical 5% 5-fluorouracil using a short-contact regimen, resulting in complete lesion clearance without recurrence. This case highlights a rare presentation and effective nonsurgical management of PKMB.

Adult acquired buried penis (AABP) is a condition in which the penis is obscured by excessive surrounding soft tissue or skin folds, commonly associated with obesity. It is often worsened by Balanitis Xerotica Obliterans or Lichen Sclerosus. It is a risk factor for penile cancer and affects self-image and mental well-being of the patient. There is limited literature comparing techniques and surgical outcomes for AABP. This retrospective cohort analysis included 46 patients, comparing "Manta Ray" (MR) versus the Elliptical Excision (EE) technique. Herein, we also describe the surgical approach of the "Manta Ray." Multivariable analysis demonstrated no significant association between surgical technique and postoperative complications. In a separate adjusted model, patients with prior weight loss had lower odds for wound dehiscence when controlling for surgical technique and BMI; however, this did not reach statistical significance. Reoperation rates were 31.8% in the EE group and 16.7% in the MR group (P =0.307). Age at the time of surgery and diabetes mellitus were not significantly associated with postoperative complications. Operative time was significantly shorter in the MR group compared with the EE group (mean 150.7 vs. 207.4 min, P =0.0018). Buried penis recurrence was infrequent in the analysis, and not significantly different between groups (EE: 13.6% vs. MR: 4.2%, P =0.336). In conclusion, the Manta Ray technique provides an aesthetic multivector exposure of the penis, with a safety and complication profile comparable to the standard EE approach, and a significantly shorter operative time.

Background: Balanoposthitis is a common presentation within sexual health services and encompasses a broad spectrum of infective, inflammatory, premalignant, and systemic conditions affecting the glans penis and foreskin. Accurate diagnosis is essential to ensure appropriate management, avoid unnecessary antimicrobial use, identify sexually transmitted infections (STIs), and recognise conditions requiring specialist referral. The 2025 guideline update was developed to strengthen recommendations on the diagnosis and management of infective balanoposthitis while improving recognition of important non-infective dermatoses and systemic disease presentations.Methods: The guideline update was informed by a review of the current evidence base, emerging clinical data, and expert multidisciplinary consensus. Existing recommendations were reviewed and revised to reflect advances in diagnostic approaches, antimicrobial stewardship, and the management of inflammatory and premalignant penile dermatoses. Particular emphasis was placed on improving diagnostic accuracy, identifying clinical features suggestive of STIs or systemic disease, and clarifying indications for biopsy and specialist referral. Discussion: The updated guideline highlights the importance of a structured clinical assessment supported by targeted investigations where appropriate. Infective causes remain an important consideration, including candidal balanoposthitis, bacterial infection, and STIs; however, the guideline also emphasises the need to recognise common inflammatory dermatoses such as lichen sclerosus, psoriasis, eczema, and Zoon balanitis, as well as premalignant and malignant conditions. The recommendations promote evidence-based treatment strategies, reduce unnecessary empirical antimicrobial prescribing, and encourage earlier identification of patients requiring dermatology, urology, or penile cancer specialist input.Conclusion: This 2025 guideline update aims to support clinicians in the earlier recognition and accurate diagnosis of balanoposthitis and related penile dermatoses. By promoting evidence-based management, antimicrobial stewardship, and timely referral for specialist care where indicated, the guideline seeks to improve patient outcomes and standardise care across sexual health and related clinical services.

Reactive arthritis is a sterile inflammatory arthritis that arises following a gastrointestinal or genitourinary tract infection, most frequently triggered by organisms such as Chlamydia trachomatis, Salmonella spp, Shigella spp, Yersinia spp, and Campylobacter spp. Reactive arthritis is classified as a seronegative spondyloarthropathy and shares characteristics with related conditions such as psoriatic arthritis and ankylosing spondylitis, but reactive arthritis is uniquely defined by its temporal association with a preceding infection. Initial symptoms typically present as acute, asymmetric oligoarthritis or monoarthritis within 1 to 6 weeks of infection, and persistent inflammation may lead to prolonged discomfort or disability in some individuals. The condition primarily affects the large joints of the lower extremities, though axial involvement may also occur. Enthesitis is a hallmark feature. Extra-articular findings are frequent and may precede, coincide with, or follow joint involvement. These findings may involve the eyes (conjunctivitis or uveitis), genitourinary tract (urethritis or cervicitis), or skin, including lesions such as keratoderma blenorrhagicum and circinate balanitis. The clinical course varies widely; while many cases resolve within several months, up to 30% of patients develop chronic or recurrent symptoms, and some progress to chronic spondyloarthritis. Reiter syndrome, historically used to describe the triad of arthritis, urethritis, and conjunctivitis after an inciting infection, represents only a subset of reactive arthritis. The term has fallen out of favor, both because it fails to capture the full clinical spectrum and due to ethical concerns regarding Hans Reiter’s role in human rights abuses. Reactive arthritis is now the preferred, more accurate term for this postinfectious inflammatory condition.

People affected by diabetes mellitus (DM), chronic kidney disease (CKD), or heart failure are often prescribed sodium-glucose cotransporter-2 inhibitors (SGLT2is) as a method of treatment. These drugs favorably affect glucose metabolism, as patients taking them have lower serum glucose levels. Another promising positive impact is protection against microvascular damage, cardiovascular disease, and chronic kidney disease. Nevertheless, fungal infections, urinary tract infections, and ketoacidosis are the adverse effects that might happen during the SGLT2i treatment. Fungal infections are more common among patients treated with these medications, including vulvovaginal Candidiasis in women and balanitis or balanoposthitis in men. Given the difficulty of treating fungal infections in patients with co-occurring diseases, we recommend that ongoing supervision of patients treated with SGLT2i include prevention and early detection of fungal infections.