The rate of lichen sclerosus (BXO) was significantly higher among male patients with acquired than congenital phimosis

Balanitis Xerotica Obliterans (BXO) in acquired Phimosis in male patients

BXO is thin white dry patches that appear on the foreskin. It can be troublesome if this is not treated. This causes tight foreskin in children and adults. This is also known as lichen sclerosus

If any male patients who has tight foreskin recently , we must exclude BXO phimosis. Literature showed that it is more likely to due to BXO

Following advice will be given

1. Topical steroids have been used. Topical steroids can offer a reliable option only in the management of mild or early BXO limited to the prepuce in boys with minimal scar formation.

2. Circumcision with frenuloplasty in adults and children with BXO may be required if there is no improvement in the tight foreskin with steroids

3. Further treatment, or treatment of circumcised patients, is more challenging. Topical steroids will require in patients after circumcision who has BXO on glans (head) penis 

4. Steroids injection provides efficacious management for urinary stricture disease in patients with biopsy ­proven BXO before invasive surgery.

Should you circumcise your newborn son? under Tricare Overseas Program (TOP) in the UK

Circumcision in newborn is very common in USA (58%).

Ideal age of newborn circumcision is 3 days to 6 weeks.

Male infant circumcision is far more common in the United States than it is in most developed countries.

The paediatric urologists agree that parents should consider the medical benefits and risks of circumcision in the context of religious, social and cultural preferences.

We offer newborn circumcision under the USA Tricare Overseas Programme in the UK for 48th Medical Group - RAF Lakenheath Brandon IP27 9PN

Please contact us as soon as the baby is born. We have 27 years experience Paediatric Urologist, 24 hours telephone support, CQC registered clinic, and Excellent patients’ experience

Care Quality Commission has given "Good" rating to London Circumcision Centre in all five domains

This service is rated as

Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

CQC carried out an announced comprehensive inspection at the London Circumcision Centre. This inspection was conducted as part of CQC inspection programme of independent health providers.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC key findings of our clinic were:

• The service had systems in place which kept patients safe. These included checks on patients attending the service and risk assessments conducted to ensure staff and patients were safe whilst attending the centre.

• Staff at the service had the skills and knowledge to provide effective care.

• Feedback on the provider and service revealed high levels of patient satisfaction.

• Provision of services at the clinic considered patient demand and included timely access appointments which included face-to-face, telephone and video consultations.

• There was a focus on innovative, learning and improvement.

Good Ratings for London Circumcision Centre

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Good Ratings for London Circumcision Centre -

CQC inspected and Rated Good

The scarred foreskin due to balanitis xerotica obliterans requires prompt treatment

Lichen sclerosus of men genitalia is usually called balanitis xerotica obliterans (BXO). This is progressive scarring with inflammatory disease of the head of the penis (also called glans penis) and foreskin. It may cause tight foreskin (called phimosis).  BXO has a significant abnormality which sometimes associated with urinary obstruction and sexual dysfunction. Medical treatment with steroids may require in early BXO.  Circumcision is indicated in the case of the tight foreskin (phimosis) due to BXO or foreskin trapped beyond the head of the penis during sexual activity (paraphimosis).

The following pathway should be adopted in the management of lichens sclerosis (BXO) phimosis

• Assessment and advice will require for the different option of treatments of BXO by our specialist Urologist 

• Consultation is important before the circumcision and other surgical procedures to know about the management. 

• Circumcision, biopsy and urethroplasty are surgical options.

• Follow up advice following the circumcision is an important part of the long-term advice. 

• Good practice to send a foreskin biopsy to confirm the diagnosis and exclude any skin cancer 

• Further steroid treatment may require treating the remaining BXO over the head of the penis after 4-6 weeks of circumcision

• Long term follow-up is required if biopsy proven BXO found after the circumcision   

Disclaimer: This information is not the replacement of medical professional advice. Please contact us for professional consultation.

Reference: Kwok R, Shah TT, Minhas S. Recent advances in understanding and managing Lichen Sclerosus. F1000Research. 2020;9.