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Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys (balanitis xerotica obliterans).

Abstract

BACKGROUND

Lichen sclerosus (LS), (balanitis xerotica obliterans), causes pathological phimosis. Many boys present with obstructive symptoms, the cause is usually obvious on examination so ultrasound scans (USS) of the urinary tract are not routinely indicated. We review a series of abnormal USS in boys with LS.

METHODS

Retrospective note review for boys undergoing surgical treatment for LS between 2000 and 2017. Seventy-eight boys had a USS prior to surgery, those with abnormal USS form the study population. Boys with neuropathic bladder or congenital urinary tract abnormalities were excluded.

RESULTS

Nineteen of 78 boys (24%), mean age 9 years, were included. Seventeen had obstructive symptoms, 13 had culture proven UTIs, 12 had new onset incontinence. On USS 3 (17%) had acute retention, 8 (78%) had an isolated post-void residual volume (PVR) >10% of estimated bladder capacity (EBC); 3 had bladder wall thickening +/- PVR >10%, 5 had upper tract changes. Symptoms resolved with successful treatment of LS. Six boys had post treatment USS, abnormalities resolved in 5.

CONCLUSIONS

Clinicians should consider LS in boys presenting with UTIs, new onset incontinence and obstructive urinary tract symptoms. Routine USS are not indicated though should be considered in those with an atypical history or examination.

TYPE OF STUDY

Case Series.

LEVEL OF EVIDENCE

Level 4.

Authors+Show Affiliations

St Helen's and Knowsley Teaching Hospital, Warrington Road, Prescot L35 5DR.Department of Surgery, Alder Hey Children's Hospital NHS Foundation Trust, East Prescott Road, Liverpool, L14 5AB, UK. Electronic address: harriet.corbett@alderhey.nhs.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31455543

Citation

Hughes, Kaylie E., and Harriet J. Corbett. "Ultrasound Evidence of Bladder Outlet Obstruction Secondary to Lichen Sclerosus Et Atrophicus in Boys (balanitis Xerotica Obliterans)." Journal of Pediatric Surgery, 2019.
Hughes KE, Corbett HJ. Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys (balanitis xerotica obliterans). J Pediatr Surg. 2019.
Hughes, K. E., & Corbett, H. J. (2019). Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys (balanitis xerotica obliterans). Journal of Pediatric Surgery, doi:10.1016/j.jpedsurg.2019.07.020.
Hughes KE, Corbett HJ. Ultrasound Evidence of Bladder Outlet Obstruction Secondary to Lichen Sclerosus Et Atrophicus in Boys (balanitis Xerotica Obliterans). J Pediatr Surg. 2019 Aug 13; PubMed PMID: 31455543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys (balanitis xerotica obliterans). AU - Hughes,Kaylie E, AU - Corbett,Harriet J, Y1 - 2019/08/13/ PY - 2019/02/25/received PY - 2019/06/19/revised PY - 2019/07/18/accepted PY - 2019/8/29/entrez KW - Balanitis xerotica obliterans KW - Bladder outlet obstruction KW - Boys KW - Lichen sclerosus KW - Ultrasound JF - Journal of pediatric surgery JO - J. Pediatr. Surg. N2 - BACKGROUND: Lichen sclerosus (LS), (balanitis xerotica obliterans), causes pathological phimosis. Many boys present with obstructive symptoms, the cause is usually obvious on examination so ultrasound scans (USS) of the urinary tract are not routinely indicated. We review a series of abnormal USS in boys with LS. METHODS: Retrospective note review for boys undergoing surgical treatment for LS between 2000 and 2017. Seventy-eight boys had a USS prior to surgery, those with abnormal USS form the study population. Boys with neuropathic bladder or congenital urinary tract abnormalities were excluded. RESULTS: Nineteen of 78 boys (24%), mean age 9 years, were included. Seventeen had obstructive symptoms, 13 had culture proven UTIs, 12 had new onset incontinence. On USS 3 (17%) had acute retention, 8 (78%) had an isolated post-void residual volume (PVR) >10% of estimated bladder capacity (EBC); 3 had bladder wall thickening +/- PVR >10%, 5 had upper tract changes. Symptoms resolved with successful treatment of LS. Six boys had post treatment USS, abnormalities resolved in 5. CONCLUSIONS: Clinicians should consider LS in boys presenting with UTIs, new onset incontinence and obstructive urinary tract symptoms. Routine USS are not indicated though should be considered in those with an atypical history or examination. TYPE OF STUDY: Case Series. LEVEL OF EVIDENCE: Level 4. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/31455543/Ultrasound_evidence_of_bladder_outlet_obstruction_secondary_to_lichen_sclerosus_et_atrophicus_in_boys_(balanitis_xerotica_obliterans) L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(19)30508-1 DB - PRIME DP - Unbound Medicine ER -