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Pathology for Urologists

Balanitis Xerotica Obliterans


Image A
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Image B
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  • Male equivalent to lichen sclerosis et atrophicus in the female.
  • Clinical: usually affects older men; presents as white patch on the glans penis or prepuce that envelops or involves the urethral meatus (image A); may be associated with induration (fibrosis) if it is long-standing.

Image C
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Image D
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  • Histology
    • Hyperkeratosis of the epidermis (looks like a buildup of eosinophilic keratin flakes on top of the epithelium).
    • Atrophy of the epidermis (look for loss of the rete pegs and overall thinning of the epidermis).
    • Dense homogenized collagenized band beneath the epidermis – looks like a pink glassy material in the superficial subcutaneous tissue (image B), (image C), & (image D).
    • Lymphoplasmacytic infiltrate beneath the collagenized band.
  • Etiology: may be idiopathic or may be associated with an underlying carcinoma.
  • Treatment: variable response to laser, circumcision, steroids, antifungals, and retinoids (in other words, the verdict is still out on an appropriate therapy).

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