FORMS OF RECURRENT BALANOPOSTHITIS: MODERN ASPECTS OF THE PROBLEM
Authors: R.I. BILOBRYVKA, V.I. POPOV, O.P. KALITCHUK
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Aim. To examine chronic recurrent forms of balanoposthitis resistant to conventional local antifungal or antiinflammatory treatment, to determine etiologic factors of balanoposthitis, and to classify balanoposthitis. Methods. The study involved 98 patients aged from 18 to 80 years with diagnosis of balanoposthitis resistant to treatment with medications for topical application. All patients underwent standard investigations, including general clinical examination, biochemical, bacteriological, serological, immunological methods, and tissue biopsy. Results. 42(42.8%) bacteriological seedings were conducted, among them were isolated Enterobacteria, S. aureus, Klebsiella, Gardnerella vaginali in 18 (18,3%) Candida albicans, E.coli and others in 6 (6.12% ), and in 16 (16.3%) 2-3 types of microorganisms. It has been confirmed that the effectiveness of treatment of bacterial and mycosis balanoposthitis depends on the overall immunity of the patient. The simultaneous treatment of sexual partners is also important. Other factors causing the disease were the human papillomavirus infection in 17 (17.3%)), complications of balanoposthitis (phimosis, paraphimosis, excessive foreskin) that need surgical treatment (circumcision) in 11 (11.1%) patients, allergic reactions, drugs and latex intolerance (20.04% ), cream base intolerance in 13 (13.2%). All patients with recurrent balanoposthitis visited a doctor 2-3 times or more within 6 months and underwent local therapy. It was determined that the greatest difficulty in the treatment of recurrent form of balanoposthitis is treatment of balanoposthitis with erosions regardless of its etiology. The most effective treatment for patients with cream base intolerance involves water-based creams and bath with KMnO4, Burov fluid (with weeping, erosions) with saline (for dry forms of balanoposthitis, and allergic reactions). For Candida balanoposthitis we used treatment of infection, sources, strengthening of body immunity, examination and treatment of sexual partners by systemic and local drugs: cream ketoconazol 2%, bifonazoli 1%, clotrimasoli 1%, econasoli nitrati 1%, miconasoli nitrati 2%, terbinafini 1%), probiotics, vitamins. Creams of broad-spectrum antibiotics (gentamicin, neomycin , tetracycline, fuzyd acid, mupirocin, bacitracin) with the addition of 10-15% zinc oxide were also effective in the treatment. Too careful and frequent hygiene of genitals is impractical for treatment because it leads to disruption of the natural microenvironment. The main factors of prevention of chronic balanoposthitis are: personal hygiene and hygiene of genitals; prevention of sexually transmitted diseases; treatment of diabetes and other chronic diseases (including male sex organs), weight loss in patients with metabolic syndrome (obesity), sex hygiene: condoms; prevention creams and lubricants for avoiding abrasions; irritation reduction; abstinence from sexual intercourse at the first symptoms of inflammation or during treatment, examination, and treatment of sexual partners.
Conclusions. The isolated skin damage of prepuce and/or head of the penis can be symptoms of systemic skin disease. Balanoposthitis is a widespread disease, with a tendency to increase in different age groups. Balanoposthitis has polymicrobial etiology; sometimes it is caused by mono infection. Physicians should pay particular attention to erosions and ulcerations that do not heal during long time on prepuce and head of the penis and require differential diagnosis with other diseases, precancerous conditions or carcinoma. Parents should monitor childhood hygiene of boys' genitals. It is necessary to separate synechias and concretion of prepuce from the head of the penis. Keywords: balanoposthitis, recurrent forms, etiology, clinical symptoms, treatment, prevention