Hi again John,

Campbell-Walsh’s Urology (4 volume version, 2007) is the most up to date reference source and probably weighs about 30 pounds. A few points, BXO is now being called “lichen sclerosus.” and reputedly could occur in circumcised men, but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the opening of the urethra and may ingress well into the pendulous urethra.

Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids and antibiotics have been recommended but surely do not work consistently. Also clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled. BXO has also been described in “buried penis” and we saw a nasty case of that about 4
months ago. Not sure which came first. Couldn’t help but feel the dense intraurethral scarring process may have contributed to inversion.

For urethral reconstruction, a buccal graft is recommened as this seems to be a process of genital skin. A buccal graft taken from the inside of the cheek is of course unrelated. We are getting well away from using penile skin for urethral reconstruction as we know only too well the effects of urine on penile skin.

In some instances, lichen sclerosus can progress to squamous cell carcinoma (cancer for our lay friends).

Again, thank you for introducing this excellent topic. I am not a real expert in this area but I guess when no one has a good cure, there are not too many experts out there.

Cheers to you, and there will always be an England!

Harold Reed, M.D.