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By Darrel Gregory,

The prepuce or foreskin as it is commonly known can sometimes be too tight to retract over the glans penis – this is called Phimosis.

Phimosis is normal in toddlers and babies and all boys are born with a tight foreskin, as the boys grow the foreskin stretches, although in some cases, this does not happen.

If it occurs in older boys it may be because a skin condition has scared the tissue.  Most can live with the condition, but may need surgical intervention should the symptoms worsen.

Steroids can sometimes help the condition for short to medium term.  Circumcision can be an option for the more severe cases.

BALANITIS XEROTICA OBLITERANS (BXO)

Balanitis Xerotica Obliterans (BXO) is an inflammatory condition of the foreskin or the glans. It may be caused by trauma, irritants or an infection. Infective balanitis is commonly caused by bacteria or fungi (yeasts) which thrive in the warm, moist, dark conditions under the foreskin. Poor hygiene or retained soap, retained smegma or inadequate drying may cause an irritant balanitis.

WHAT IS BALANITIS XEROTICA OBLITERANS (BXO) FORESKIN?

BXO is a thin white crinkly patch that appears on the foreskin. It can be troublesome if this is not treated. This is also known lichen sclerosis atrophicus or white spot disease.

WHO GETS THE BXO

BXO is a disease that can affect uncircumcised males of all ages ranging from young boys to adolescent and adults. This is the commonest cause of tightening of the foreskin (BXO phimosis)

WHAT CAUSES THE BXO?

The exact cause of BXO is unknown. Sometimes it is associated with diseases in which the body’s immune system attacks normal tissues. Despite the tendency to affect genital skin, BXO is not an infection and is not contagious, so sexual partners cannot pick it up. Rarely, BXO can occur in relatives.

WHAT ARE THE SYMPTOMS OF BXO?

Many patients have none, but the most common symptom of BXO is itching. As a rule the patches on the foreskin itch and can also be sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with sexual intercourse in affected men. BXO can make the foreskin tight and difficult to retract, and can even partly block the flow of urine.

If you have this problem,  then you can call us confidentially to find out availability.

 

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By Darrel Gregory,

Luton – audit results

The widespread acceptance of adult local anaesthesia circumcision in the community remains debatable. We report outcomes (Glue and Stiches) from a dedicated GP clinic over two year period. Patient demographics, indications and postoperative complications were recorded prospectively.

Of 373 circumcisions (glue n=269 and stitches n=103), 230 patients had therapeutic indications including 63 (17%) balanitis xerotica obliterans and 11 (2.9%) had minor complications (infection n=6, bleeding n=2 and redo n=3) with no significant difference between the two groups.

Circumcision performed in adults remains a safe surgical option under local anaesthesia in dedicated GP surgeries. Glue circumcision gives excellent result for adult circumcision.

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By john@ergodigital.com,

Non-therapeutic male circumcision in children with a novel disposable ring – Circumplast improves the outcome as compared to the standard Plastibell device at a community clinic.

This cohort study evaluates the early postoperative complications in Circumplast and Plastibell techniques, in a community clinic, for non-therapeutic male circumcision.

Material & Methods

We reviewed the outcome of non-therapeutic male circumcision in children (n=1387) over a 1 year period (May 2014 to April 2015) in a community clinic, performed under local anaesthesia, by trained doctors with the backup of a trained paediatric surgeon. The technique was selected by doctors’ preference. Data was collected prospectively and early postoperative complications were compared between Circumplast & Plastibell circumcisions. Follow-up consultations were arranged if required.

Results

  • The mean age was 18 ± 1.9 months (median 5.1) in Circumplast circumcision (CC) and 9.4 ± 0.6 months (median 1.5) in Plastibell circumcision (PC).
  • Incidence of complications is significantly lower in CC (6.3% n=13/208) versus PC (13% n=154/1179).
  • Delayed ring separation/migration is significantly lower in CC (3.2% n=7/208) versus PC (8.7% n=102/1179).
  • Post-operative bleeding (0.5% vs 0.6% n= 1 vs 7), preputial adhesions (1.4% vs 2.4% n= 3 vs 28), and miscellaneous complications (0.5% vs 1% n= 1 vs 13) were lower but not statistically significant (p>0.5) in CC versus PC respectively.
  • Postoperative use of antibiotics was higher in CC versus PC (6.7% vs 3.8% n=14 vs 45) but not statistically significant.
  • In children under 6 months, the overall outcome in both groups is significantly better in comparison to 6 – 110 months old.
  • Mean follow-up consultations were 19 days (range 1 to 373) in CC and 20 days (range 1 to 305) in PC.

Conclusions

Non-therapeutic male circumcision by the Circumplast device has a significantly lower risk of early postoperative complications in a community clinic, especially migration / impaction of the ring when compared to the standard Plastibell device.

Comment by the clinic:

This is our latest audit from Thornhill Circumcision Centre. This audit was presented by one of our doctors in the meeting of paediatric urologists at Harrogate, Yorkshire, UK on 23 June 2016 at the congress”

Slide Show of the Presentation

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