Balanitis Xerotica Obliterans

Question 1

Explain BXO

Answer 1

There are adhesions between the prepuce and the glans at birth that should gradually break down with time.

Mean age of 1st foreskin retraction is 10.4 years.

By age of 16 only 1% have phimosis still, which means that 1% at age of 16 will have physiological phimosis

Around 95% of pathological phimosis is due to BXO.

There is keratinisation of the tip of the foreskin that causes scarring and the prepuce will remain non-retractile.

This peak incidence is 9-11 years.

Question 2

Clinical features

Answer 2

Balloning of the foreskin during micturition but is normal at age 2-4 yo.

Scarring of urethral meatus + irritation, dysuria, haematuria and local infection.

If the meatus is involved it can also cause urinary obstruction.

Question 3

Examination findings

Answer 3

White, fibrotic and scarred preputial tip.

Can be difficult to visualise the meatus

Question 4

Management

Answer 4

Circumcision

Send foreskin off to histopathology to confirm diagnosis

Question 5

Complications

Answer 5

Give topical abx when doing circumcision

Bleeding and infection can happen post-treatment

Swelling and serous discharge can also happen post-op.

Untreated BXO can lead to meatal stenosis, phimosis, erosion of glans and prepupce and can extend to the urethra