The surgical treatment of Balanitis Xerotica Obliterans

Abstract

Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage. Materials and Methods: Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed. Results: Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group. Conclusions: Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

10 Years' Experience in Balanitis Xerotica Obliterans: A Single-Institution Study

“…Circumcision is curative in most cases. 1,18 In our study, 87.9% of patients had a circumcision alone with no additional procedure at the initial operation, and 80.2% did not require any further intervention at any later time point. Hence, our study shows that circumcision is an effective treatment method for BXO.…”

“…The condition usually presents in the adult population (between 30 and 60 years), but is the most common cause of pathological phimosis in the pediatric population. 1,2 In the pediatric population, the reported incidence of BXO in children undergoing circumcision for phimosis is estimated between 14.5 and 27%. [3][4][5][6] BXO is a progressive condition initially presenting with a gray-white skin discoloration on the foreskin, but can spread to affect the glans, meatus, and urethra.…”

“…Acutely, it may present with erythema in the surrounding area accompanied by fissuring and blisters. 1,7 Subsequent fibrosis may lead to the chronic form consisting of dense, white patches. Untreated disease can lead to complications including phimosis, urethral strictures, meatal stenosis, micturition problems, and sexual dysfunction.…”

Folia Medica Cracoviensia

“…Balanitis Xerotica Obliterans (BXO) is a chronic, progressive, sclerosing inflammation of unclear etiology, that presents on the external genitalia of males and more specifically the prepuce and its frenulum, the glans, the external urethral meatus and the peripheral part of the urethra [1]. When neglected, it may affect the entire urethra, penile skin and scrotum [2,3].…”

Clinical Effectiveness of Intralesional Injections of Triamcinolon Acetonide in Patients with Patients with Lichen Sclerosus on the Penis

“…При неефективності топічної терапії та локалізації в ділянці препуціуму застосовують обрізання крайньої плоті [18]. З деструктивних хірургічних методів лікування з різною ефективністю застосовують кріотерапію, вуглекислі та неаблятивні лазери [1,2].…”