The treatment of balanitis xerotica obliterans
Introduction
Balanitis xerotica obliterans (BXO), first described in 1928 by Stuhmer, is now considered to be the male genital variant of lichen sclerosus et atrophicus (LSA). This common penile disease can involve the prepuce, the glans ( Fig. 1) or the urethra, either individually or in any combination. BXO was regarded as an exclusively adult disease until a case was documented in a 7‐year‐old boy in 1962 [1]. Further reports of prepubertal BXO followed during the 1970s and currently it is recognized as a common cause of acquired phimosis and meatal stenosis in schoolboys, and has even been identified in the first year of life (unpublished communication). It remains speculation as to whether this represents a genuine change in prevalence and behaviour of this disease, or merely greater clinical awareness and recognition.

Photograph of a patient with BXO affecting the foreskin and glans (a). In another patient the pointer highlights the typical white appearance of BXO meatal stricture (b).
The aetiology of BXO remains obscure. Genetic factors have been implicated in association with HLA subtypes [2], which may explain our observation of brothers, or of fathers and sons, presenting with this condition. Several publications [3, 4] including ours, noted an increased incidence of other auto‐immune type conditions (e.g. diabetes, vitiligo, alopecia), not only among patients, but also their close relatives. An infective aetiology has also been considered although initial studies on viruses [5], spirochetes [6] and acid‐fast bacilli [7] were inconclusive or unsubstantiated.
Clinical features
The clinical presentation and severity of BXO can vary markedly. The onset may be insidious, pursuing a chronic course over many years with few early symptoms, or it may behave aggressively with florid disease evident within weeks of onset. In mild early BXO, the patient may notice areas of greyish white discoloration on the glans or the moist inner layer of the foreskin. It may or may not be itchy, and at this stage it is frequently misdiagnosed as a candidal infection and treated to no avail with antifungal creams. The involved areas of skin coalesce or spread, becoming inelastic and prone to fissuring or haemorrhagic blistering during sexual activity. The frenulum often becomes contracted and circumferential involvement of the preputial aperture leads to a progressive fibrous phimosis, characterized by the typical whitish discoloration. In aggressive BXO disease the surface of the glans and inner prepuce may ulcerate, causing purulent discharge. Subsequent fibrosis may lead to dense fusion of the layers, thereby making a routine circumcision difficult or impossible. The intermittent ulceration of the glans is often histologically not specific, but eventually this chronic instability may progress to squamous cell carcinoma (SCC), which has a recognized association with BXO. For these reasons, circumcision of a severe BXO phimosis in which the glans cannot be inspected or in which there is an associated purulent discharge, should not be delegated to an inexperienced surgeon.
Urethral involvement starts at the meatus, with a tendency to form superficial adhesions between the meatal lips in the milder cases, and then the typical dense ivory‐white fibrosis in more severe disease ( Fig. 1b). Although traditionally it was thought that BXO did not progress beyond the navicular fossa, our extensive experience shows that in long‐standing disease, mucosal involvement and spongiofibrosis can spread proximally as far back as the prostate. However, it has not been found in bladder mucosa. Clinically the penile urethra may feel like a thickened cord on palpation, and on urethroscopy (when possible) the involved mucosa looks pale and ‘shaggy’, sometimes with focal areas of fissuring or ulceration. The proximal extent is usually well demarcated when in the penile urethra, although with more extensive bulbar extension of the disease, the mucosal changes may fade indistinctly and we have sometimes noted the appearance of minor mucosal ‘skip’ lesions beyond the apparent posterior limit. However, generally the disease seems to spread proximally from the meatus in a confluent manner.
With experience, the clinical picture of established BXO is almost unmistakable, although the differential diagnosis might include lichen planus, localized scleroderma, leukoplakia, vitiligo and the cutaneous rash of Lyme disease. Furthermore, on histological examination BXO presents a very characteristic picture. Hyperkeratosis is present and the epidermis is atrophic with thinning of the rete pegs. Vacuolar degeneration of the basal layer may be present. The papillary and reticular dermis present a ‘washed out’ appearance and dermal collagen forms a homogenous band at the dermal‐epithelial junction in conjunction with elastin fibres, to produce an amorphous hybrid substance [8]. Deep to this amorphous band, a chronic inflammatory cell infiltration is present, mainly from T cells [9].
Treatment
BXO has been managed both medically and surgically. Currently available medical treatment can provide useful palliation but is generally regarded to be of limited benefit. Topically applied and intralesionally injected steroids have been shown to arrest the progression of the disease and in some cases cause regression or resolution, particularly in childhood phimosis. A trial with clobetasol or mometasone cream can be considered for those patients with early disease who are keen to avoid circumcision. However, on ceasing treatment the disease process may resume [10, 11]. Topically applied testosterone has been reported to have a beneficial effect, but this type of treatment has not been pursued further [12].
The surgical options are more definitive, and have included circumcision, dilating or surgically correcting meatal stenosis, and various urethroplasty techniques. The carbon dioxide laser has been used as an alternative to incisional surgery to ablate BXO on the glans [13-15] and for the dilatation of proximal strictures [16, 17].
Because previous reports include few patients and use uncertain treatment regimens, we reviewed a large series of histologically confirmed cases of BXO operated on by the senior author (A.B.), to establish a treatment protocol. To date, the senior author has treated ≈ 700 patients for BXO and its sequelae; 522 of these patients, operated on between January 1984 and May 1998, were studied retrospectively by reviewing the case‐notes and the senior author's database ( Table 1). Those who had BXO as their main pathology were treated surgically, 82 (16%) patients were treated for hypospadias with concurrent BXO and 12 (2%) had treatment for SCC associated with BXO ( Table 1).
| Pathology or site | No. (%) of patients |
|---|---|
| Total | 522 |
| BXO main pathology | 428 (82) |
| BXO with hypospadias | 82 (16) |
| BXO with SCC | 12 (2) |
| Site: | |
| Limited to foreskin/glans | 300 (57) |
| Involving meatus | 21 (4) |
| Urethral | 107 (20) |
The age of presentation of BXO was difficult to assess because many of the patients were referred from other units, having undergone several previous procedures over many years. Thus we assessed the subset of patients presenting for primary surgical treatment by circumcision, which would give a more accurate assessment. In the 300 patients treated by circumcision the youngest was a 2‐year‐old boy and the eldest an 81‐year‐old man. The median age at presentation was 33 years, with the highest incidence in those aged 21–40 years (145 patients, 48%).
Of these 300 patients with BXO limited to the foreskin or glans penis only, 287 (96%) were treated by circumcision alone. The remaining 13 (4%) required concurrent surgical procedures, i.e. meatotomy or meatoplasty in five, urethroplasty using mucosal grafts in four and glans resurfacing in four.
Of the 287 patients who had the glans exposed by circumcision alone as the definitive treatment, the disease process was arrested and symptoms relieved in 276 (92%). BXO remained active in 11 (3.9%) patients, with development of glans ulceration requiring total glans resurfacing in five, and with urethral spread requiring urethroplasty in six. Surgery to correct meatal stenosis was undertaken in 21 (4%) patients in the form of meatotomy (13) or meatoplasty (eight).
In all, 107 (20%) patients underwent surgery for a BXO urethral stricture, with excision of the involved urethra and replacement with grafts, the choice of graft changing with our length of experience. Initially, in 42 (39%) of these cases, skin (genital or not) was used for substitution, and although the early results were good, there was an almost 90% stricture recurrence rate during a long‐term follow‐up. The other 65 patients (61%), plus the recurrences from the skin group, underwent reconstruction with buccal and/or bladder mucosa. There have been no BXO recurrences in these mucosal grafts to date.
Of those with BXO, 82 (16%) were identified among patients who were being treated for hypospadias problems. Of these 82, 29 (35%) were presenting late for primary repair because a hitherto asymptomatic hypospadias deformity had become troublesome. Fifty‐three (65%) were referred for salvage surgery having already undergone unsuccessful hypospadias repairs elsewhere. Most were adults with a long history of recurrent strictures and multiple hospitalizations. Our experience in managing these patients mirrors that in patients with no hypospadiac stricture, i.e. those repairs that used skin to reconstruct the urethra eventually stenosed, whereas those using mucosal grafts have remained free of recurrence.
Penile SCC was associated with BXO in 12 (2.3%) patients; of these, seven had been circumcised earlier for BXO whilst the other five had BXO in uncircumcised penises. These patients were treated by conservative resection, combined with reconstruction of a pseudo‐glans. One of these patients developed a BXO urethral stricture requiring urethroplasty; another developed metastatic spread of his carcinoma, requiring an inguinal lymph node block dissection.
Discussion
BXO can be treated in several ways; of the 300 patients treated by circumcision, in all but 12 (4%) this was the only intervention required, underlining the efficacy of this mode of treatment. BXO has a predilection for the warm, moist, urine‐exposed environment that exists under the foreskin. In removing the moist skin folds and allowing the glans epithelium to dry out, circumcision usually leads to either resolution or arrest in progression of the disease, and alleviation of the symptoms. Mild glans disease may revert to a normal appearance within 6 months, and with more severe involvement, resolution may continue for up to 2 years after circumcision, although some permanent atrophic scarring and discoloration may then remain. Several authors [18, 19] have suggested that total excision of the involved epithelium is an effective way of eliminating the risk of recurrence. However, in our experience the associated desiccating effect of circumcision also plays an important role, and we recommend that sufficient foreskin should therefore be removed to allow adequate exposure and drying out of the glans. We have noted recurrence of BXO when the circumcision has been very conservative, even though the clinically diseased skin was removed. Recurrence is also common when residual moist skin folds are unavoidable because of obesity. Even after radical circumcision, in the obese patient the shaft skin may roll up to form a pseudo‐foreskin as the penis invaginates into the pubic fat pad. In these patients, despite repeated surgery, the entire penile shaft skin may eventually be destroyed and therefore radical weight loss is a priority for these patients if they are to avoid becoming genital ‘cripples’.
In a minority of cases the glans continues to deteriorate despite adequate circumcision, and the patient may have recurrent blistering, fissuring or ulceration of the skin. Twelve such patients were treated with topical clobetasol cream applied twice daily to the glans, but on follow‐up they continued to have problems. Five of them had persistent instability and ulceration of the glans surface ( Fig. 2ab), which was effectively treated by complete resection of the glans epithelium and resurfacing with partial thickness skin grafts ( Fig. 2c,d). The other seven developed urethral strictures requiring urethroplasty with buccal mucosa; on follow‐up these patients remain well. The reason that skin grafts seem to be effective on the circumcised glans but not in the urethra is that in the former the skin remains dry.

Long‐term disfigurement and instability in a patient after an attempted circumcision in advanced BXO (a), with fusion between the foreskin and glans (b). (c,d) show the cosmetic and functional improvement 6 months after complete denuding and exteriorization of the glans, then resurfacing with partial thickness skin grafts from the thigh.
BXO is a common disease, yet its true incidence is not appreciated because most cases are cured by circumcision, and unfortunately many surgeons still fail to send their circumcision specimens for histology. This practice is becoming medicolegally indefensible in a litigation‐conscious society, where the clinical sequelae of BXO are often misinterpreted by the patient as surgical errors. It is important to recognize when an unretractile foreskin is the result of established BXO, as these patients may have already developed a buried corona or more extensive fusion between the foreskin and glans, thereby making circumcision a challenging procedure. Failure to fully separate the adhesions will not only compromise the aesthetic outcome of circumcision, but may lead to recurrent painful fissuring around the corona during sexual activity. Given also the possibility of concurrent meatal or urethral stricture, or of malignant transformation, circumcision in these patients should not be delegated to an unsupervised trainee surgeon. Indeed, in severe cases, primary referral to a plastic surgeon or reconstructive urologist may be advisable.
BXO involvement of the urethra presents the challenging objective of restoring adequate urinary flow whilst minimizing the risk of recurrence. Various treatments have been recommended for meatal stenosis. Topical or injected steroids have shown some benefit [1, 20] especially when used as an adjunct to other treatments [21]. A simple ventral slit in the terminal urethra followed by dilatation tends to cause a distal hypospadias deformity and often leads to recurrence. Meatoplasty has been claimed to achieve a better functional result and a more permanent treatment of the stenosis [22]. The carbon dioxide laser has been used to treat meatal stenosis by ablation and meatotomy [17], or circumferential vaporization [16], with encouraging results. In our experience meatal stenosis may respond well to the above modalities, provided that circumcision has also been performed, and that the disease process is still confined to the meatal margins. Unfortunately, re‐stenosis can be anticipated once there is established BXO in the distal urethra. Urethroscopy is therefore mandatory if symptoms or clinical examination are suggestive of spread into the urethra.
To treat established urethral disease, excision of the involved urethra and substitution urethroplasty is the modality of choice. Conservative management with repeated urethrotomies and dilatations only exacerbates the fibrosis and recurrence of the stricture is virtually inevitable [23]. There is consensus that the involved urethral segment should be excised, and that delay merely allows the disease to spread further proximally, thereby making the subsequent surgery more difficult.
Various ways of reconstructing the urethra have been tried, including the use of pedicled skin flaps or skin grafts [24]. Our management of the urethra with BXO will be discussed in more detail elsewhere but from an experience of ≈ 200 BXO strictures we can draw several conclusions.
First, the diseased segment of urethra should be excised and substituted, rather than augmented with inlay flaps or grafts. Second, substitution urethroplasty with either genital or extra‐genital skin grafts provides no cure. The short‐term results may be excellent, but if such patients are followed for long enough then recurrent BXO strictures are almost inevitable. Re‐stricturing commonly occurs within the first 2–3 years, but it may take longer, and we have noted recurrences up to 10 years later. In the early 1990s we therefore started to use mucosa for reconstruction, and to date have encountered no recurrent BXO in a mucosal substitution urethroplasty.
We prefer a two‐stage procedure where first the urethra is laid open, and the involved mucosa excised and replaced by a graft of buccal mucosa harvested from one or both cheeks. The urethra is reconstituted at a second operation ≈ 4 months later. If the length of urethra involved is too much to replace with buccal mucosa alone, then we use buccal mucosa for the terminal segment and at the second operation replace the remaining diseased urethra with tubed bladder mucosa.
In the hypospadias‐BXO group, most salvage referrals presented with recurring strictures resulting from various types of hypospadias repair that use skin for the neourethra. BXO was confirmed on histological examination and the problems rectified when mucosa was used instead. The many hypospadias patients with BXO are unlikely to represent any specific association between these conditions, but probably reflects referral patterns to the unit because of the senior author's interest in hypospadias salvage.
Various authors [25-28] have reported the association between BXO and SCC of the glans, although by what mechanism this occurs and whether this is a specific causal relationship remains unclear. Some regard BXO as an inherently premalignant condition, whereas others consider it an unspecific irritant focus, comparable with chronic scarring or ulceration that eventually progresses to a Marjolin's ulcer. In our series, 12 patients with BXO (2.3% of 522) presented with SCC (median age 61.5 years, range 32–79); five presented with SCC in an uncircumcised penis, but intriguingly in the other seven the carcinoma had developed despite a previous circumcision for BXO phimosis. Why SCC of the glans should develop years after BXO circumcision remains unanswered, although it is possible that undiagnosed carcinoma in situ was already established at the time of primary surgery. We recommend that suspicious or atypical areas of BXO should be biopsied to exclude malignant transformation, especially in patients aged over 30 years.
Our patients were managed surgically, usually by glansectomy alone, but combined with a conservative amputation of the distal shaft if there was tumour penetration through to the corporal heads. We routinely reconstruct a pseudo‐glans by resurfacing the corporal heads or the contoured amputation stump with a split‐thickness skin graft from the thigh. This gives excellent functional and cosmetic results without compromising survival. Metastatic spread of the carcinoma occurred in only one patient, who required block dissection of the groin and has had no subsequent problems. We are now convinced, after a 10‐year experience with conservative surgery, that the traditional mutilating operations described for penile carcinoma are unwarranted in stage 1 and 2 disease, and our rationale will be the subject of a separate publication.
We stress that radiotherapy is not a treatment option for carcinoma of the glans when associated with BXO, because BXO spreads aggressively and relentlessly in immuno‐compromised, irradiated tissues, leading to florid and extensive involvement of the external genital skin and of the urethra. The management of such cases is exceedingly difficult.
A suggested treatment protocol
This is probably the largest series of BXO to date and therefore we suggest a protocol for the surgical treatment of BXO as currently practised in our unit.
•If the condition, as observed clinically, is limited to the foreskin, then circumcision is curative and provides histological confirmation of the disease.
•If there is associated glans discoloration, but with no scarring, ulceration or fusion to the foreskin, simple circumcision is again likely to be curative.
•Potent topical steroid creams may be a useful adjunct to manage localized areas that are reluctant to settle after circumcision, but we regard steroids as palliative rather than curative.
•If the coronal sulcus is obliterated by adhesions and the remaining glans skin is in reasonable condition, then we recommend release of the buried coronal ridge by careful sharp dissection, and allowing healing by secondary re‐epithelialization of the raw area.
•If the glans is extensively scarred and disfigured, or if the surface remains unstable and symptomatic, then total resurfacing of the glans with healthy new skin is recommended. This improves the aesthetic appearance and should remove the risk of progression to SCC.
•If SCC of the glans occurs, it is best treated by conservative, reconstructive surgery; radiotherapy should be avoided.
•Meatal BXO may respond to minor surgery and topical steroids, but stenosis is likely to recur if there is already established involvement of the distal urethra.
•The treatment for urethral BXO is excision of the involved urethra and substitution with full thickness buccal mucosa, or a combination of buccal and bladder mucosa in more extensive disease.
Conclusion
We present a treatment protocol ( Table 2) reflecting the experience in our unit of treating > 500 patients with BXO over a 14‐year period. Because few cases have been reported to date there is little consistent advice on the treatment of this under‐diagnosed condition. The protocol provides a treatment plan for managing most cases of BXO. Whilst many straightforward cases could be managed in a general surgery environment, it should be recognized that the sequelae of BXO can be technically challenging, and a proportion of patients will benefit from the services of a reconstructive specialist.
| BXO involvement | Treatment |
|---|---|
| Limited to foreskin | Circumcision ± release of adhesions |
| Histology | |
| Topical steroids as an alternative if very mild/asymptomatic | |
| Glans | Mild/moderate: circumcision and observation (± topical steroids) |
| Severe: glans resurfacing | |
| SCC: resection and reconstruction | |
| Meatal | Early: dilatation (± topical steroids) |
| Established: meatotomy/meatoplasty and urethroscopy | |
| Urethral | Excise BXO urethra and replace with mucosal graft |
| Short segment: buccal | |
| Long segment: buccal and bladder |
Authors
I. Depasquale, Senior House Officer.
A.J. Park, FRCS, Specialist Registrar.
A. Bracka, FRCS, Consultant in Genitourethral Plastic Surgery.
Number of times cited: 148
- Anthony Hall, Lichen Sclerosus, Atlas of Male Genital Dermatology, 10.1007/978-3-319-99750-6_19, (61-65), (2018).
- G. Kravvas, T.N. Shim, P.R. Doiron, A. Freeman, C. Jameson, S. Minhas, A. Muneer and C.B. Bunker, The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients, Journal of the European Academy of Dermatology and Venereology, 32, 1, (91-95), (2017).
- F.M. Lewis, F.M. Tatnall, S.S. Velangi, C.B. Bunker, A. Kumar, F. Brackenbury, M.F. Mohd Mustapa and L.S. Exton, British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018, British Journal of Dermatology, 178, 4, (839-853), (2018).
- Arie Stewart Parnham, Gideon Adam Blecher and Suks Minhas, Treatment of the Primary Tumor: Role of Organ-Preserving Surgery in Penile Cancer, Urologic Oncology, 10.1007/978-3-319-42603-7_35-1, (1-13), (2018).
- Andrew T. Gabrielson, Tan V. Le, Christopher Fontenot, Mustafa Usta and Wayne J.G. Hellstrom, Male Genital Dermatology: A Primer for the Sexual Medicine Physician, Sexual Medicine Reviews, 10.1016/j.sxmr.2018.09.004, (2018).
- Mohamed Sultan, Mohamed El-Shazly, Eid Elsherif, Sheren Younes and Mohamed Selim, Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair, Arab Journal of Urology, 15, 4, (326), (2017).
- Carlos González-Cruz and Carla Ferrándiz-Pulido, Liquen escleroso genital, Piel, 10.1016/j.piel.2017.05.025, (2017).
- Lauren B. McCaffrey, Heather A. Brandling-Bennett, Kate O. Khorsand, Joy Lynn Mombourguette, Rebecca S. Kunder, Grace S. Sun, Nina T. Washington, Regina-Celeste Ahmad, Shelley Yang, Fan Liu, Alexander Fogel and Joyce M. C. Teng, Collagen Vascular Diseases, Therapy in Pediatric Dermatology, 10.1007/978-3-319-43630-2_22, (377-407), (2016).
- Jessica DeLong, Kurt McCammon, Leandro Capiel, Augustín Rovegno, Jeremy B. Tonkin, Gerald Jordan and Ramón Virasoro, Augmented perineal urethrostomy using a dorsal buccal mucosal graft, bi-institutional study, World Journal of Urology, 35, 8, (1285), (2017).
- A. A. Sokolova, N. F. Zatorskaia, O. V. Medvedeva, V. N. Grebenyuk and O. R. Katynina, Current approaches to the treatment and management of male patients with genital lichen sclerosus, Klinicheskaya dermatologiya i venerologiya, 16, 3, (70), (2017).
- J.C. Angulo, I. Arance, C. Esquinas, D. Nikolavsky, N. Martins and F. Martins, Treatment of long anterior urethral stricture associated to lichen sclerosus, Actas Urológicas Españolas (English Edition), 41, 2, (123), (2017).
- Richard Edward Watchorn and Christopher Barry Bunker, Genital diseases in the mature man, Clinics in Dermatology, 10.1016/j.clindermatol.2017.10.011, (2017).
- P.R. Doiron and C.B. Bunker, Obesity‐related male genital lichen sclerosus, Journal of the European Academy of Dermatology and Venereology, 31, 5, (876-879), (2016).
- J.C. Angulo, I. Arance, C. Esquinas, D. Nikolavsky, N. Martins and F. Martins, Tratamiento de la estenosis larga de uretra anterior asociada a liquen escleroso, Actas Urológicas Españolas, 41, 2, (123), (2017).
- Hunter Wessells, Keith W. Angermeier, Sean Elliott, Christopher M. Gonzalez, Ron Kodama, Andrew C. Peterson, James Reston, Keith Rourke, John T. Stoffel, Alex J. Vanni, Bryan B. Voelzke, Lee Zhao and Richard A. Santucci, Male Urethral Stricture: American Urological Association Guideline, The Journal of Urology, 197, 1, (182), (2017).
- Michael A. Granieri, Andrew C. Peterson and Ramiro J. Madden-Fuentes, Effect of Lichen Sclerosis on Success of Urethroplasty, Urologic Clinics of North America, 44, 1, (77), (2017).
- Paul Hadway, Peter R. Malone and Asif Muneer, Management of Penile Cancer Using Penile-Preserving Techniques, Textbook of Penile Cancer, 10.1007/978-3-319-33220-8_10, (133-144), (2017).
- Mahmoud Ziada, Christopher B Bunker and Asif Muneer, Premalignant penile lesions, Journal of Clinical Urology, 9, 4, (216), (2016).
- Warren Snodgrass, Juan Soto Blanquel and Nicol Corbin Bush, Recurrence after management of meatal balanitis xerotica obliterans, Journal of Pediatric Urology, (2016).
- Miodrag Acimovic, Bogomir Milojevic, Marko Milosavljevic, Marta Skrodzka, Milan Radovanovic, Dragutin Rafailovic, Zoran Dzamic, Jovan Hadzi Djokic and Rados Djinovic, Primary dorsal buccal mucosa graft urethroplasty for anterior urethral strictures in patients with lichen sclerosus, International Urology and Nephrology, 48, 4, (541), (2016).
- Sarah R. Ottenhof, Maaike C. G. Bleeker, Daniëlle A. M. Heideman, Peter J. F. Snijders, Chris J. L. M. Meijer and Simon Horenblas, Etiology of Penile Cancer, Textbook of Penile Cancer, 10.1007/978-3-319-33220-8_2, (11-15), (2017).
- C.J. Shukla and Suks Minhas, Penile reconstruction and trauma, Male Sexual Dysfunction, (283-293), (2016).
- Chintan K. Patel, Jill C. Buckley, Leonard N. Zinman and Alex J. Vanni, Outcomes for Management of Lichen Sclerosus Urethral Strictures by 3 Different Techniques, Urology, 91, (215), (2016).
- Majid Shabbir and Paul K. Hegarty, Penile cancer, Male Sexual Dysfunction, (276-282), (2016).
- Majid Shabbir, Christopher Bunker and Asif Muneer, Premalignant Lesions of the Penis, Textbook of Penile Cancer, 10.1007/978-3-319-33220-8_9, (115-131), (2017).
- Kenneth W. Angermeier, Editorial Comment, Urology, 91, (220), (2016).
- Bradley A. Potts, Michael J. Belsante and Andrew C. Peterson, Intraurethral Steroids are a Safe and Effective Treatment for Stricture Disease in Patients with Biopsy Proven Lichen Sclerosus, The Journal of Urology, 195, 6, (1790), (2016).
- Niels V. Johnsen, Elizabeth T. Brown, W. Stuart Reynolds, Melissa R. Kaufman, Douglas F. Milam and Roger R. Dmochowski, Diagnosis and Management of Male Genital Lichen Sclerosus, Current Bladder Dysfunction Reports, 10.1007/s11884-016-0375-2, 11, 3, (234-241), (2016).
- Tharani Mahesan, Paul K. Hegarty and Nicolas A. Watkin, Advances in Penile-Preserving Surgical Approaches in the Management of Penile Tumors, Urologic Clinics of North America, 43, 4, (427), (2016).
- Ulf Håkansson, Peter Kirrander, Bengt Uvelius, Gediminas Baseckas and Christian Torbrand, Organ-sparing reconstructive surgery in penile cancer: initial experiences at two Swedish referral centres, Scandinavian Journal of Urology, 49, 2, (149), (2015).
- Catherine M. Corbishley, Brendan Tinwell, Asheesh Kaul, Benjamin Ayres and Nicholas A. Watkin, Glans resurfacing for precancerous and superficially invasive carcinomas of the glans penis: Pathological specimen handling and reporting, Seminars in Diagnostic Pathology, 32, 3, (232), (2015).
- Juan Carlos Regueiro Lopez, Enrique Gomez Gomez, Alberto Alonso Carrillo, Roque Cano Castiñeira and Maria Jose Requena Tapia, Perineostomy: the last oportunity, International braz j urol, 41, 1, (91), (2015).
- Michelle Christodoulidou, Varun Sahdev, Selda Houssein and Asif Muneer, Epidemiology of penile cancer, Current Problems in Cancer, 39, 3, (126), (2015).
- Antonio Carlos Lima Pompeo, Stênio de Cássio Zequi and Alexandre Saad Feres Lima Pompeo, Penile cancer, Current Opinion in Urology, 25, 2, (121), (2015).
- Lana X. Tong, Grace S. Sun and Joyce M.C. Teng, Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options, Pediatric Dermatology, 32, 5, (593-599), (2015).
- G. Kirtschig, K. Becker, A. Günthert, D. Jasaitiene, S. Cooper, C.‐C. Chi, A. Kreuter, K.K. Rall, W. Aberer, S. Riechardt, F. Casabona, J. Powell, F. Brackenbury, R. Erdmann, M. Lazzeri, G. Barbagli and F. Wojnarowska, Evidence‐based (S3) Guideline on (anogenital) Lichen sclerosus, Journal of the European Academy of Dermatology and Venereology, 29, 10, (e1-e43), (2015).
- Eric S. Wisenbaugh and Joel Gelman, The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease, Advances in Urology, 2015, (1), (2015).
- Francisco E. Martins, Sanjay B. Kulkarni, Pankaj Joshi, Jonathan Warner and Natalia Martins, Management of Long-Segment and Panurethral Stricture Disease, Advances in Urology, 2015, (1), (2015).
- Joceline S. Liu, Kelly Walker, Daniel Stein, Sanjiv Prabhu, Matthias D. Hofer, Justin Han, Ximing J. Yang and Chris M. Gonzalez, Lichen Sclerosus and Isolated Bulbar Urethral Stricture Disease, The Journal of Urology, 192, 3, (775), (2014).
- J. Pérez-Niño, N. Fernández and G. Sarmiento, Penectomía parcial y reconstrucción peneana. Manejo quirúrgico inicial del cáncer de pene localizado, Actas Urológicas Españolas, 38, 1, (62), (2014).
- Yue-Min Xu, Chao Feng, Ying-Long Sa, Qiang Fu, Jiong Zhang and Hong Xie, Outcome of 1-Stage Urethroplasty Using Oral Mucosal Grafts for the Treatment of Urethral Strictures Associated With Genital Lichen Sclerosus, Urology, 83, 1, (232), (2014).
- M. Fernández Fernández, A. Pérez Bustillo, J. Martínez Sáenz de Jubera, L.M. Rodríguez Fernández and F.J. Gallo Rolania, Estenosis del meato uretral secundaria a liquen escleroso, Anales de Pediatría, 80, 3, (188), (2014).
- Paul K. Hegarty, Ian Eardley, Axel Heidenreich, W. Scott McDougal, Suks Minhas, Philippe E. Spiess, Nick Watkin and Simon Horenblas, Penile cancer: organ‐sparing techniques, BJU International, 114, 6, (799-805), (2014).
- Paul Hadway, Varun Sahdev, Manit Arya and Asif Muneer, Recent developments and current management of penile cancer, Clinical Practice, 11, 2, (169), (2014).
- Soledad Celis, Francisco Reed, Feilim Murphy, Stephen Adams, John Gillick, Abdelhafeez H. Abdelhafeez and Pedro-Jose Lopez, Balanitis xerotica obliterans in children and adolescents: A literature review and clinical series, Journal of Pediatric Urology, 10, 1, (34), (2014).
- Laurence Stewart, Kurt McCammon, Michael Metro and Ramon Virasoro, SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra—Lichen Sclerosus, Urology, 83, 3, (S27), (2014).
- Lucy Homer, Katharine J. Buchanan, Batoul Nasr, Paul D. Losty and Harriet J. Corbett, Meatal Stenosis in Boys following Circumcision for Lichen Sclerosus (Balanitis Xerotica Obliterans), The Journal of Urology, 192, 6, (1784), (2014).
- J. Pérez-Niño, N. Fernández and G. Sarmiento, Partial penectomy and penile reconstruction. Initial surgical management of localized penile cancer, Actas Urológicas Españolas (English Edition), 38, 1, (62), (2014).
- Spencer I. Kozinn, Niall J. Harty, Leonard Zinman and Jill C. Buckley, Management of Complex Anterior Urethral Strictures With Multistage Buccal Mucosa Graft Reconstruction, Urology, 82, 3, (718), (2013).
- Susanna K. Fistarol and Peter H. Itin, Diagnosis and Treatment of Lichen Sclerosus, American Journal of Clinical Dermatology, 14, 1, (27), (2013).
- Marcello Cimador, Santiago Vallasciani, Gianantonio Manzoni, Waifro Rigamonti, Enrico De Grazia and Marco Castagnetti, Failed hypospadias in paediatric patients, Nature Reviews Urology, 10, 11, (657), (2013).
- Anowar Ali Mallick, Tapas Kumar Majhi, Supriya Basu and Dilip Kumar Pal, Balanitis Xerotica Obliterans, the Topical Application of Tacrolimus Ointment, and the Result: An Institutional Study, UroToday International Journal, 06, 02, (2013).
- Giulio Garaffa, Vincenzo Gentile, Gabriele Antonini, Petros Tsafrakidis, Amr Abdel Raheem and David J. Ralph, Penile reconstruction in the male, Arab Journal of Urology, 11, 3, (267), (2013).
- Zekayi Kutlubay, Burhan Engin, Tuba Zara and Yalçın Tüzün, Anogenital malignancies and premalignancies: Facts and controversies, Clinics in Dermatology, 31, 4, (362), (2013).
- Hema J. Thakar and Daniel D. Dugi, Skin Grafting of the Penis, Urologic Clinics of North America, 40, 3, (439), (2013).
- K. Becker, V. Meissner, W. Farwick, R. Bauer and M.R. Gaiser, Lichen sclerosus and atopy in boys: coincidence or correlation?, British Journal of Dermatology, 168, 2, (362-366), (2013).
- K. Becker, Atopy, the barrier, urine and genital lichen sclerosus: reply from the authors, British Journal of Dermatology, 169, 4, (953-954), (2013).
- Prodromos Philippou, Majid Shabbir, David J. Ralph, Peter Malone, Raj Nigam, Alex Freeman, Asif Muneer and Suks Minhas, Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis, BJU International, 111, 6, (970-976), (2013).
- Kimberly L. Brady, Mary Gail Mercurio and Marc D. Brown, Malignant Tumors of the Penis, Dermatologic Surgery, 39, 4, (527-547), (2012).
- Giulio Garaffa, Salvatore Sansalone and David J Ralph, Penile reconstruction, Asian Journal of Andrology, 15, 1, (16), (2013).
- H.D. Hoving, A.H. van Houten and J.M. Nijman, Case report. Twee patiënten met late gevolgen van lichen sclerosus: niet enkel beperkt tot de huid, Tijdschrift voor Urologie, 3, 1, (18), (2013).
- Warren T. Snodgrass, Hypospadias, Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00130-4, (3503-3536.e5), (2012).
- David J. Wilkinson, Nick Lansdale, Lucy H. Everitt, Sean S. Marven, Jenny Walker, Rang N. Shawis, J.P. Roberts, A.E. Mackinnon and P.P. Godbole, Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans, Journal of Pediatric Surgery, 47, 4, (756), (2012).
- S. Jayakumar, B. Antao, O. Bevington, P. Furness and G.K. Ninan, Balanitis xerotica obliterans in children and its incidence under the age of 5 years, Journal of Pediatric Urology, 8, 3, (272), (2012).
- Ty T. Higuchi, Yuka Yamaguchi, Hadley M. Wood and Kenneth W. Angermeier, Evaluation and Treatment of Adult Concealed Penis, Current Urology Reports, 13, 4, (277), (2012).
- Curtis A. Pettaway, Raymond S. Lance and John W. Davis, Tumors of the Penis, Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00034-7, (901-933.e9), (2012).
- E.V.J. Edmonds, S. Hunt, D. Hawkins, M. Dinneen, N. Francis and C.B. Bunker, Clinical parameters in male genital lichen sclerosus: a case series of 329 patients, Journal of the European Academy of Dermatology and Venereology, 26, 6, (730-737), (2011).
- Steven J. Hudak, Jessica D. Lubahn, Sanjay Kulkarni and Allen F. Morey, Single‐stage reconstruction of complex anterior urethral strictures using overlapping dorsal and ventral buccal mucosal grafts, BJU International, 110, 4, (592-596), (2011).
- Ather M. Abdelbaky, Pavan Aluru, Philip Keegan and Damien R. Greene, Development of male genital lichen sclerosus in penile reconstruction skin grafts after cancer surgery: an unreported complication, BJU International, 109, 5, (776-779), (2011).
- Rajan Veeratterapillay, K. Sahadevan, Pavan Aluru, Susan Asterling, G.S. Rao and Damian Greene, Organ‐preserving surgery for penile cancer: description of techniques and surgical outcomes, BJU International, 110, 11, (1792-1795), (2012).
- N. Lumen, W. Oosterlinck and P. Hoebeke, Urethral Reconstruction Using Buccal Mucosa or Penile Skin Grafts: Systematic Review and Meta-Analysis, Urologia Internationalis, 89, 4, (387), (2012).
- Ahmet Ali Sancaktutar, Hüseyin Kilinçaslan, Murat Atar, Haluk Söylemez, Necmettin Penbegül, YaŞar Bozkurt and Abdulkadir Tepeler, Severe phimosis leading to obstructive uropathy in a boy with lichen sclerosus, Scandinavian Journal of Urology and Nephrology, 46, 5, (371), (2012).
- Enzo Palminteri, Steven B. Brandes and Miroslav Djordjevic, Urethral reconstruction in lichen sclerosus, Current Opinion in Urology, 22, 6, (478), (2012).
- Timothy J. Tausch and Andrew C. Peterson, Early Aggressive Treatment of Lichen Sclerosus May Prevent Disease Progression, The Journal of Urology, 187, 6, (2101), (2012).
- Oliver Kayes, Majid Shabbir and Suks Minhas, Male Genital Premalignant Dermatoses, Current Urology Reports, 13, 6, (488), (2012).
- Neil H. Cox and John S. C. English, Inflammatory Dermatoses, British Association of Dermatologists' Management Guidelines, (1-90), (2011).
- Dayne M. Nelson and Andrew C. Peterson, Lichen Sclerosus: Epidemiological Distribution in an Equal Access Health Care System, The Journal of Urology, 185, 2, (522), (2011).
- Giulio Garaffa, Amr Abdel Raheem and David John Ralph, An update on penile reconstruction, Asian Journal of Andrology, 13, 3, (391), (2011).
- Majid Shabbir, Asif Muneer, Jas Kalsi, Chitranjan J. Shukla, Evangelos Zacharakis, Giulio Garaffa, David Ralph and Suks Minhas, Glans Resurfacing for the Treatment of Carcinoma In Situ of the Penis: Surgical Technique and Outcomes, European Urology, 59, 1, (142), (2011).
- Rajkumar Mathur, Gaurav Aggarwal, Bhaskar Satsangi, Fareed Khan and Sudarshan Odiya, Comprehensive analysis of etiology on the prognosis of urethral strictures, International braz j urol, 37, 3, (362), (2011).
- Majid Shabbir, Suks Minhas and Asif Muneer, Diagnosis and management of premalignant penile lesions, Therapeutic Advances in Urology, 3, 3, (151), (2011).
- Apul Goel, Anuj Goel and Abhishek Jain, Buccal Mucosal Graft Urethroplasty for Penile Stricture: Only Dorsal or Combined Dorsal and Ventral Graft Placement?, Urology, 77, 6, (1482), (2011).
- A. McSorley and A.K. Nigam, Is routine histology necessary in circumcision?, British Journal of Medical and Surgical Urology, 4, 4, (148), (2011).
- David Clouston, Anthony Hall and Nathan Lawrentschuk, Penile lichen sclerosus (balanitis xerotica obliterans), BJU International, 108, s2, (14-19), (2011).
- Anthony R. Mundy and Daniela E. Andrich, Urethral strictures, BJU International, 107, 1, (6-26), (2010).
- Samuel Deem, Thomas Keane, Robin Bhavsar, Ahmed El‐Zawahary and Stephen Savage, Contemporary diagnosis and management of squamous cell carcinoma (SCC) of the penis, BJU International, 108, 9, (1378-1392), (2011).
- Giulio Garaffa, Majid Shabbir, Nim Christopher, Suks Minhas and David J. Ralph, The Surgical Management of Lichen Sclerosus of the Glans Penis: Our Experience and Review of the Literature, The Journal of Sexual Medicine, 8, 4, (1246-1253), (2011).
- LEONARD H. GOLDBERG, JENNIFER M. LANDAU, MEGAN N. MOODY and IRENE J. VERGILIS‐KALNER, Treatment of Bowen's Disease on the Penis with Low Concentration of a Standard Mixture of Solasodine Glycosides and Liquid Nitrogen, Dermatologic Surgery, 37, 6, (858-861), (2011).
- Á. Gómez-Ferrer, J. Rubio-Briones, A. Collado, M. Trassierra, J. Casanova, J.L. Monrós, J.V. Ricós, M.Á. Bonillo, I. Iborra and E. Solsona, Reconstrucción del glande con injerto cutáneo libre según técnica de Bracka, Actas Urológicas Españolas, 35, 3, (180), (2011).
- C. Hofer, F.-M. Köhn, G.S. Hatzichristodoulou, J.E. Gschwend and U. Treiber, Lichen sclerosus im Urogenitalbereich, Der Urologe, 50, 10, (1291), (2011).
- Giulio Garaffa, Amr Abdel Raheem and David John Ralph, Penile Fracture and Penile Reconstruction, Current Urology Reports, 12, 6, (427), (2011).
- Samuel M. Lawindy, Alejandro R. Rodriguez, Simon Horenblas and Philippe E. Spiess, Current and Future Strategies in the Diagnosis and Management of Penile Cancer, Advances in Urology, 10.1155/2011/593751, 2011, (1-9), (2011).
- Á. Gómez-Ferrer, J. Rubio-Briones, A. Collado, M. Trassierra, J. Casanova, J.L. Monrós, J.V. Ricós, M.Á. Bonillo, I. Iborra and E. Solsona, Reconstruction of the glans with free-skin graft applying the Bracka technique, Actas Urológicas Españolas (English Edition), 35, 3, (180), (2011).
- N. Panait and P. Mouriquand, Prepucio estrecho en el niño, EMC - Pediatría, 45, 1, (1), (2010).
- S.M. Neill, F.M. Lewis, F.M. Tatnall and N.H. Cox, British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010, British Journal of Dermatology, 163, 4, (672-682), (2010).
- V. Monsálvez, R. Rivera and F. Vanaclocha, Lichen Sclerosus, Actas Dermo-Sifiliográficas (English Edition), 101, 1, (31), (2010).
- Daniel A. Barocas and Sam S. Chang, Penile Cancer: Clinical Presentation, Diagnosis, and Staging, Urologic Clinics of North America, 37, 3, (343), (2010).
- V. Monsálvez, R. Rivera and F. Vanaclocha, Liquen escleroso, Actas Dermo-Sifiliográficas, 101, 1, (31), (2010).
- Suks Minhas, Andreas Manseck, Stephen Watya and Paul K. Hegarty, Penile Cancer—Prevention and Premalignant Conditions, Urology, 10.1016/j.urology.2010.04.007, 76, 2, (S24-S35), (2010).
- Paul L. Crispen and Jack H. Mydlo, Penile Intraepithelial Neoplasia and Other Premalignant Lesions of the Penis, Urologic Clinics of North America, 10.1016/j.ucl.2010.04.003, 37, 3, (335-342), (2010).
- Matthew S. Christman, Jamesina T. Chen and Nicholas M. Holmes, Obstructive complications of lichen sclerosus, Journal of Pediatric Urology, 5, 3, (165), (2009).
- Luis Martínez-Piñeiro, Editorial Comment on: Lichen Sclerosus of the Male Genitalia and Urethra: Surgical Options and Results in a Multicenter International Experience with 215 Patients, European Urology, 55, 4, (954), (2009).
- Paul K. Hegarty, Majid Shabbir, Ben Hughes, Suks Minhas, Matthew Perry, Nicholas Watkin and David J. Ralph, Penile preserving surgery and surgical strategies to maximize penile form and function in penile cancer: recommendations from the United Kingdom experience, World Journal of Urology, 27, 2, (179), (2009).
- Deirdre M. Bochove-Overgaauw, Wim Gelders and Ann M.A. De Vylder, Routine biopsies in pediatric circumcision: (Non) sense?, Journal of Pediatric Urology, 5, 3, (178), (2009).
- Jeremy B. Tonkin and Gerald H. Jordan, Management of distal anterior urethral strictures, Nature Reviews Urology, 6, 10, (533), (2009).
- Roberto Salvioni, Andrea Necchi, Luigi Piva, Maurizio Colecchia and Nicola Nicolai, Penile cancer, Urologic Oncology: Seminars and Original Investigations, 27, 6, (677), (2009).
- N. Panait and P. Mouriquand, Prépuce serré chez l'enfant, EMC - Pédiatrie - Maladies infectieuses, 4, 4, (1), (2009).
- E. Edmonds, S. Mavin, N. Francis, D. Ho‐Yen and C. Bvunker, Borrelia burgdorferi is not associated with genital lichen sclerosus in men, British Journal of Dermatology, 160, 2, (459-460), (2008).
- Sanjay Kulkarni, Guido Barbagli, Deepak Kirpekar, Francesco Mirri and Massimo Lazzeri, Lichen Sclerosus of the Male Genitalia and Urethra: Surgical Options and Results in a Multicenter International Experience with 215 Patients, European Urology, 55, 4, (945), (2009).
- Apul Goel, Anuj Goel, Diwakar Dalela and Satya N. Sankhwar, Meatoplasty using double buccal mucosal graft technique, International Urology and Nephrology, 41, 4, (885), (2009).
- Nicholas Watkin, Reconstructive surgery in penile cancer, Textbook of Reconstructive Urologic Surgery, 10.3109/9780203091487-81, (668-674), (2013).
- Anne K. Ebert, Wolfgang H. Rösch and Thomas Vogt, Safety and Tolerability of Adjuvant Topical Tacrolimus Treatment in Boys with Lichen Sclerosus: A Prospective Phase 2 Study, European Urology, 54, 4, (932), (2008).
- Vishal Bhalani, Tobias S. Köhler and Robert E. Brannigan, Common penile dermatoses, Current Sexual Health Reports, 5, 3, (124), (2008).
- D.M. Prowse, E.N. Ktori, D. Chandrasekaran, A. Prapa and S. Baithun, Human papillomavirus‐associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma, British Journal of Dermatology, 158, 2, (261-265), (2007).
- Gideon Sandler, Emily Patrick and Danny Cass, Long standing balanitis xerotica obliterans resulting in renal impairment in a child, Pediatric Surgery International, 24, 8, (961), (2008).
- Alchiede Simonato, Andrea Gregori, Carlo Ambruosi, Fabio Venzano, Virginia Varca, Andrea Romagnoli and Giorgio Carmignani, Lingual Mucosal Graft Urethroplasty for Anterior Urethral Reconstruction, European Urology, 54, 1, (79), (2008).
- Marcos A. Scheiner, Mercia M. Campos, Antonio A. Ornellas, Eduardo W. Chin, Maria H. Ornellas and Maria J. Andrada-Serpa, Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features, International braz j urol, 34, 4, (467), (2008).
- Ramón Virasoro and Gerald H. Jordan, Lichen Sclerosus, Urethral Reconstructive Surgery, 10.1007/978-1-59745-103-1_3, (19-28), (2008).
- Allen F. Morey, H. Cathy Lin, Chad A. DeRosa and Brian C. Griffith, Fossa Navicularis Reconstruction: Impact of Stricture Length on Outcomes and Assessment of Extended Meatotomy (First Stage Johanson) Maneuver, The Journal of Urology, 177, 1, (184), (2007).
- Christine McKillop, Interview with Dr Guido Barbagli Substitution Urethroplasty: Which Tissues and Techniques are Optimal for Urethral Replacement?, European Urology, 52, 2, (602), (2007).
- Laurence A. Levine, Kurt H. Strom and Matthew M. Lux, Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical Outcome, The Journal of Urology, 178, 5, (2011), (2007).
- Guido Barbagli and Massimo Lazzeri, Surgical treatment of anterior urethral stricture diseases: brief overview, International braz j urol, 33, 4, (461), (2007).
- Jennifer M. Pugliese, Allen F. Morey and Andrew C. Peterson, Lichen Sclerosus: Review of the Literature and Current Recommendations for Management, The Journal of Urology, 178, 6, (2268), (2007).
- A.-K. Ebert, T. Vogt and W.H. Rösch, Die topische Therapie der Balanitis xerotica obliterans im Kindesalter, Der Urologe, 46, 12, (1682), (2007).
- Guido Barbagli and Massimo Lazzeri, Urethral reconstruction, Current Opinion in Urology, 16, 6, (391), (2006).
- Guido Barbagli, Michele De Angelis, Enzo Palminteri and Massimo Lazzeri, Failed Hypospadias Repair Presenting in Adults, European Urology, 49, 5, (887), (2006).
- K. Rödder, R. Olianas and M. Fisch, Urethralstriktur – operative Konzepte, Der Urologe, 45, 4, (499), (2006).
- PETER PIETRZAK, PAUL HADWAY, CATHY M. CORBISHLEY and NICHOLAS A. WATKIN, Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?, BJU International, 98, 1, (74-76), (2006).
- ZOAN I. RADOJICIC, SAVA V. PEROVIC and KRSTE D.J. STOJANOSKI, Calibration and dilatation with topical corticosteroid in the treatment of stenosis of neourethral meatus after hypospadias repair, BJU International, 97, 1, (166-168), (2005).
- PAUL HADWAY, CATHY M. CORBISHLEY and NICHOLAS A. WATKIN, Total glans resurfacing for premalignant lesions of the penis: initial outcome data, BJU International, 98, 3, (532-536), (2006).
- T. Windahl, Is carbon dioxide laser treatment of lichen sclerosus effective in the long run?, Scandinavian Journal of Urology and Nephrology, 40, 3, (208), (2006).
- G. Barbagli, E. Palminteri, F. Mirri, G. Guazzoni, D. Turini and M. Lazzeri, Penile Carcinoma in Patients With Genital Lichen Sclerosus: A Multicenter Survey, The Journal of Urology, 175, 4, (1359), (2006).
- PATRICIO C. GARGOLLO, HARRY P. KOZAKEWICH, STUART B. BAUER, JOSEPH G. BORER, CRAIG A. PETERS, ALAN B. RETIK and DAVID A. DIAMOND, BALANITIS XEROTICA OBLITERANS IN BOYS, The Journal of Urology, 174, 4, (1409), (2005).
- D DUBEY, A SEHGAL, A SRIVASTAVA, A MANDHANI, R KAPOOR and A KUMAR, BUCCAL MUCOSAL URETHROPLASTY FOR BALANITIS XEROTICA OBLITERANS RELATED URETHRAL STRICTURES: THE OUTCOME OF 1 AND 2-STAGE TECHNIQUES, The Journal of Urology, 173, 2, (463), (2005).
- András Kiss, László Király, Balázs Kutasy and Miklós Merksz, High Incidence of Balanitis Xerotica Obliterans in Boys with Phimosis: Prospective 10‐Year Study, Pediatric Dermatology, 22, 4, (305-308), (2005).
- Deepak Dubey, Anant Kumar, Anil Mandhani, Aneesh Srivastava, Rakesh Kapoor and Mahendra Bhandari, Buccal mucosal urethroplasty: a versatile technique for all urethral segments, BJU International, 95, 4, (625-629), (2005).
- Sanjeev Misra, Arun Chaturvedi and Naresh C Misra, Penile carcinoma: a challenge for the developing World, The Lancet Oncology, 5, 4, (240), (2004).
- Gianantonio Manzoni, Aivar Bracka, Enzo Palminteri and Giacinto Marrocco, Hypospadias surgery: when, what and by whom?, BJU International, 94, 8, (1188-1195), (2004).
- Andrew C. Peterson and George D. Webster, Management of urethral stricture disease: developing options for surgical intervention, BJU International, 94, 7, (971-976), (2004).
- Andrew C. Peterson, Enzo Palminteri, Massimo Lazzeri, Giorgio Guanzoni, Guido Barbagli and George D. Webster, Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans), Urology, 64, 3, (565), (2004).
- R. Liloku, P. Buisson and P. Mouriquand, prépuce serré chez l'enfant, Journal de Pédiatrie et de Puériculture, 16, 1, (12), (2003).
- G. Barbagli, E. Palminteri, M. Lazzeri and G. Guazzoni, Anterior urethral strictures, BJU International, 92, 5, (497-505), (2003).
- D. Dubey, A. Kumar, P. Bansal, A. Srivastava, R. Kapoor, A. Mandhani and M. Bhandari, Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques, BJU International, 91, 3, (215), (2003).
- ENZO PALMINTERI, MASSIMO LAZZERI, GIORGIO GUAZZONI, DAMIANO TURINI and GUIDO BARBAGLI, NEW 2-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY, The Journal of Urology, 167, 1, (130), (2002).
- ENZO PALMINTERI, MASSIMO LAZZERI, GIORGIO GUAZZONI, DAMIANO TURINI and GUIDO BARBAGLI, NEW 2-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY, The Journal of Urology, (130), (2002).
- Swetha Prabhakaran, Damir Ljuhar, Robert Coleman and Ramesh M Nataraja, Circumcision in the paediatric patient: A review of indications, technique and complications, Journal of Paediatrics and Child Health, , (2018).
- Santo Raffaele Mercuri, Pina Brianti, Antonio Foti, Marco Bartolucci, Annunziata Dattola and Steven Paul Nisticò, Penile Lichen Sclerosus Treated with 1927 nm Thulium Fiber Laser and Photodynamic Therapy: A New Possible Therapeutic Approach, Photomedicine and Laser Surgery, 10.1089/pho.2017.4386, (2018).
- Jinfeng Li, Changkai Deng and Qiang Peng, Underestimation of genital lichen sclerosus incidence in boys with phimosis: results from a systematic review, Pediatric Surgery International, 10.1007/s00383-018-4357-7, (2018).




