I am one of several moderators on Inter-Circ. Today I had a post from an adult who was circumcised for BXO. Because he has some distortion and whitish areas on his glans and the frenaulr area, he is keen to find out antyhing he can about the latest and most efficacious treatments for BXO.

 I wonder if you would care to comment about this or if I may refer him to your group. CErtainly I can understand his concern over this very distressing disorder.If this is accpetable to you, I should be pleased to forward his original post to me.

 Thanks in advance for your care and concern in perfroming excellent adult circumcisions

  Cheers,

 John M

Hello John,

Hardly a month goes by when we don’t see a bonafide case of BXO.

Therapy focuses on prevention of disease progression.  Shelley reported some success with long-term antibiotic therapy. However, relapses were seen upon stopping treatment.  Some success has been reported with topical steroids, when scarring is minimal, though some have found this ineffectual.  Moderate therapeutic results have been reported using etretinate.  Some success has been reported in the use of carbon dioxide laser therapy.

Many authors report that circumcision is the treatment of choice, with modifications if necessary. Pasieczny suggests testosterone ointment, however.

Glansectomy may be required, but that would be unsual. Invasion into the urethra and urethral strictures (narrowing) is not uncommon. We have tried 5 FU cream in one patient, but if you read comments, there is no truly 100% effective treatment.

Could be a pre-malignant situation. Now that his glans is clearly exposed, he should map out his glans with a ruler in millimeters and note any changes in demarcation. If advancing, back to the urologist.

Excision and letting the covered tissues see the light of day is still our first line approach.

Have a restful weekend,

Harold M. Reed, M.D.

I have balanitis xerotica obliterans and have been put on a waiting list for a circumcision in the UK - I am emmigrating to New Brunswick Canada next month and will need this operation when I get there.    Gordon  contact: Email

Good afternoon Gordon,

Thank you for your interest in what we do.  BXO, now called by the preferred term lichen sclerosis, does need to be treated because of its slow premalignant potential Several reports have suggested the development of squamous cell carcinoma.  More commonly there is a slow spread and  tendency to grow into the urethra and producing scars and strictures there.  At times, the foreskin in some areas is densely adherent to the glans (head of the penis).  We see this a few times a year and have performed very possibly more adult cosmetic circumcisions in our office than anywhere else in the United States.  Well over 5000 thus far.  Usually several every week.

Please do not be like the patients we hear from every so often who send in photos 2 days after their procedure with obvious hideous result, and ask “what do I do now.”  Needless to say, a fair amount of circumcision revisions are also done here.

This is your circumcision and we do it the way you want.  There are four important parameters.  A hand held mirror is available in the operating room so you can be assured that each detail is done in accordance to your wishes.

We are looking forward to seeing you in Miami soon and showing you every courtesy.  White stuff has to go.

Sincerely,

Harold M. Reed, M.D.
305-865-2000