Balanitis Xerotics Obliterans BXO

Balanitis xerotics obliterans (BXO) is also known as lichen sclerosis atrophicus of the male genitalia is a chronic inflammatory process which affects the foreskin but can also extend onto the glans and external urethral meatus. The top of the foreskin will not retract and there can be pale scarred areas around the tip of the foreskin. It can be extremely painful but present in boys with difficult in voiding. Management is a formal circumcision. Post operatively topical steroids will be applied to decrease the need for further surgery.

Symptoms

Generally young men complain of discomfort. Some times the penis is sore and burning. The foreskin becomes tighter and tighter and is unretractable. It can consist of bleeding and occasionally there can be small tears visible at the top of the foreskin. Young men can find that their ability to void slows gradually over time.

BXO on examination, the top of the foreskin is quite tight and can not be retracted. Generally the issues can look quite variable. Occasionally the skin over the top of the penis will be very white and shiny. Sometimes the skin can become quite inflamed or on some occasions it can be quite thin and very pale or alternatively quite thick. It is important to seek medical advice if there are any concerns as it will need to be treated.

BXO is generally diagnosed on clinical examination and the tissue is normal sent for histology if the child is circumcised to confirm this.

Causes

In reality, the cause for this condition is unclear. It generally affects men who are uncircumcised. It is extremely rare in those young boys who have been circumcised in the neonatal period. There is no evidence of any infection and no particular cause has ever been detected.

Treatments

At this moment in time we recommend circumcision to be performed. There is some debate that foreskins can be left intact with injection of steroids or the use of topical steroids. This has currently not been proven and due to the ongoing risks associated with this condition, we would recommend a formal circumcision to ensure this is BXO through histology and guarantee the situation has treated properly.

Post-Surgery

We prescribe a small amount chloramphenicol cream to be used for a number of days to allow the tissues to settle down. At around 5 days after surgery, a course of hydrocortisone cream is used twice a day for 6 weeks to stop the meatus from narrowing. It is our experience that this may help make a significant difference to the insistence of meatal stenosis in this population. Your child will then attend a follow-up review to ensure that their opening is nice and wide and they are voiding without any difficulties.

BXO if left for the long term can be extremely severe and cause a huge amount of pain. Prolonged BXO can also allow the opening of the penis to narrow and this can require the need for further surgery and dilatation. There is also an association with penile cancer in later life if undiagnosed.

FAQ’s

Balanitis xerotica obliterans is a chronic inflammatory process of the foreskin and is also known as lichen sclerosis.
In reality, the cause for this condition is unclear. It generally affects men who are uncircumcised. It is extremely rare in those young boys who have been circumcised in the neonatal period. There is no evidence of any infection and no particular cause has ever been detected.
Generally young men complain of discomfort. Some times the penis is sore and burning. The foreskin becomes tighter and tighter and is unretractable. It can consist of bleeding and occasionally there can be small tears visible at the top of the foreskin. Young men can find that their ability to void slows gradually over time.
BXO on examination, the top of the foreskin is quite tight and can not be retracted. Generally the issues can look quite variable. Occasionally the skin over the top of the penis will be very white and shiny. Sometimes the skin can become quite inflamed or on some occasions it can be quite thin and very pale or even quite thick. It is important to seek medical advice if there are any concerns as it will need to be treated.
BXO is generally diagnosed on clinical examination and the tissue is normal sent for histology if the child is circumcised to confirm this.
At this moment in time we recommend circumcision to be performed. There is some debate that foreskins can be left intact with injection of steroids or the use of topical steroids. This has currently not been proven and due to the ongoing risks associated with this condition, we would recommend a formal circumcision to ensure this is BXO through histology and guarantee the situation has treated properly.
We prescribe a small amount chloramphenicol cream to be used for a number of days to allow the tissues to settle down. At around 5 days after surgery, a course of hydrocortisone cream is used twice a day for 6 weeks to stop the meatus from narrowing. It is our experience that this may help make a significant difference to the insistence of meatal stenosis in this population. Your child will then attend a follow-up review to ensure that their opening is nice and wide and they are voiding without any difficulties.
BXO if left for the long term can be extremely severe and cause a huge amount of pain. Prolonged BXO can also allow the opening of the penis to narrow and this can require the need for further surgery and dilatation. There is also an association with penile cancer in later life if undiagnosed.

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Mr. Feilim Murphy

MB, BCH, BAO, FRCSI (Paeds)
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