Balanitis Xerotica Obliterans

Question 1

What is balanitis xerotica obliterans?

Answer 1

• At birth there are adhesions between the prepuce (foreskin) and the glans of penis
• Over time these break down
• Mean age of foreskin retraction is 10.4 years and only 1% of phimosis perists at age 16
• BXO is where keratinisation of the tip of the foreskin causes scarring and the foreskin remains non-retractile
• Peak incidence 9-11 years

Question 2

Symptoms of BXO

Answer 2

• Ballooning of foreskin during micturition - BUT this is NORMAL in non-retractile foreskin in patients aged 2-4 years, self resolves as prepuce becomes more mobile with age
• Scaring of urethral meatus = irritation, dysuria, haematuria, local infection
• If extensive - urinary obstruction

Question 3

Examination findings of balanitis xerotica obliterans

Answer 3

• White, fibrotic and scarred preputial tip
• Difficult to visualise meatus - can be scarred and similar appearance
• If physiological phimosis - will be non-retractile but no scarring or meatal involvement

Question 4

Management of BXO

Answer 4

• Circumcision
• Send foreskin off to histopathology

Question 5

Circumcision procedure

Answer 5

• Simple
• Usually done as day case
• Dissolvable sutures used covered with surgical glue
• Topical abx prescribed (rather than oral)

Question 6

Complications of circumcision

Answer 6

• Bleeding - IV access if significant, pressure dressing and contact surgeon
• Infection
• Swelling - for 1 week
• Serous discharge - for 1 week

Question 7

Complications of untreated BXO

Answer 7

• Meatal stenosis
• Phimosis
• Erosions of glans and prepuce with can extend to urethra