Tight foreskin - Phimosis in adult and children

 Is this associated with Balanitis Xerotica Obliterans (BXO) and what is best evidence based management?

“No consistently effective treatment has been developed for penile lichen sclerosus (balanitis xerotica obliterans [BXO]); however, the therapies described below have varying degrees of reported success.

1.      Topical and intralesional steroids have been used. Topical steroids can offer a reliable option only in the management of mild BXO limited to the prepuce in boys with minimal scar formation. Patients and their families must have realistic expectations with regard to the success of such treatments.

2.      Circumcision in adult and children with BXO

3.      Further treatment, or treatment of circumcised patients, is more challenging. Intraurethral steroids provide efficacious therapy for stricture disease in patients with biopsy ­proven BXO before invasive surgery.

4.      A variety of surgical techniques can be used to treat more severe penile BXO. Uncircumcised patients usually benefit from therapeutic circumcision. Provide regular follow­ up care to observe any changes in involved areas suggestive of malignancy. Foreskin preputioplasty combined with intralesional triamcinolone might be a tenable alternative as against circumcision to treat BXO.

5.      Consider surgical intervention for symptoms or signs of urethral meatal stenosis.

6.      Buccal mucuosal graft for BXO ­induced urethral stricture can work.

7.      Consultations :  Consider consultation with Dr. Khan  for the following:

a.      Therapeutic circumcision

b.      Circumcision for symptomatic phimosis or paraphimosis

c.      Significant narrowing or obstruction of the urethral meatus or changes in urinary flow

d.      In some cases of male genital lichen sclerosus (BXO), painful erections may limit sexual function.”

Source: http://emedicine.medscape.com/article/1074054

London circumcision Centre, Leyton and Thornhill clinic, Luton are the best circumcision clinic to management of tight foreskin with  penile BXO. 

PATHWAY FOR PATIENTS WITH PHIMOSIS (BXO)  

1. Assessment and advice for option of treatment like steroid cream or circumcision  

2. Consultation before the circumcision  

3. Circumcision with glue because glue circumcision is better than stitches

4. Aftercare advice following the circumcision  

5. To send biopsy to confirm diagnosis and exclude any malignancy 

6. Further treatment after 6 weeks of circumcision  

7. Follow up to GP or at our clinic  

8. Long term follow up required if biopsy proven BXO found after the circumcision  

 

This is only guidance and not replacement of the professional advice by  Dr. Khan