{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:45:28Z","timestamp":1791499528730,"version":"4.3.4"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T00:00:00Z","timestamp":1606089600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T00:00:00Z","timestamp":1606089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003500","name":"Universit\u00e0 degli Studi di Padova","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003500","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The diagnosis of balanitis xerotica obliterans (BXO) in children may be challenging, since clinical examination only could lead to an underestimation of its incidence. The aim of this retrospective and single-centre study is to assess the diagnostic performance of clinical examination, together with clinical history, in identifying BXO. Ninety-seven children underwent circumcision for phimosis from 2015 to 2019. Histology was routinely performed. Cohen\u2019s kappa coefficient, sensitivity, specificity, predictive values, likelihood ratios and accuracy of macroscopic appearance of the foreskin, steroid administration and past medical history were estimated. Forty-eight patients (50%) were affected by BXO; 31 of them (69%) presented with suggestive clinical signs. A strictured or whitish urethral meatus was detected during surgery in nine cases (19%); this was associated to allergic or immune diseases (<jats:italic>p<\/jats:italic>\u2009=\u20090.046). Foreskin appearance alone mildly correlated with histology (<jats:italic>k<\/jats:italic>\u2009=\u20090.494; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and it showed a diagnostic accuracy of 75%. The specificity and positive predictive value of abnormal macroscopic findings at examination, together with a positive clinical history for other allergic or immune diseases, and\/or for balanitis, were 100% and the positive likelihood ratio was greater than 10. Conversely, sensitivity decreased to 4.5% (95% CI 0\u201311%).<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Foreskin appearance together with clinical history could predict BXO with certainty. However, since the absence of a positive medical history could not exclude the diagnosis, foreskin histology is still highly recommended.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Occurrence of balanitis xerotica obliterans may be underestimated in children and it could lead to long-term complications.<\/jats:italic><jats:italic>\u2022 The diagnostic accuracy of clinical examination is controversial.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 Clinical signs together with patients\u2019 medical history present high specificity and positive predictive values but low sensitivity.<\/jats:italic><jats:italic>\u2022 When suggestive clinical aspects are present, patient should be referred to surgery avoiding prolonged conservative treatment; and preputial histology is highly recommended.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-020-03881-4","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T19:03:56Z","timestamp":1606158236000},"page":"591-595","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Could a careful clinical examination distinguish physiologic phimosis from balanitis xerotica obliterans in children?"],"prefix":"10.1007","volume":"180","author":[{"given":"Filippo","family":"Ghidini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-9416","authenticated-orcid":false,"given":"Calogero","family":"Virgone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Pulvirenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Trovalusci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Gamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,23]]},"reference":[{"issue":"7","key":"3881_CR1","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1111\/j.1442-2042.2006.01449.x","volume":"13","author":"TF Hsieh","year":"2006","unstructured":"Hsieh TF, Chang CH, Chang SS (2006) Foreskin development before adolescence in 2149 school-boys. 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No ethical approval is required. However, a notification regarding this study was sent to the local Ethic Committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained from legal guardians of all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors adhered to STROBE guidelines (EQUATOR Network) during the preparation of the study.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Standards of reporting"}},{"value":"No custom-made software was used for this study. All statistical analyses were conducted with IBM\u00ae SPSS Inc. version 26.0.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}]}}