Surgical Guide to Circumcision by David A. Bolnick Martin Koyle & Assaf Yosha

Author:David A. Bolnick, Martin Koyle & Assaf Yosha
Language: eng
Format: epub
Publisher: Springer London, London

Indications for Circumcision

Lichen sclerosis or balanitis xerotica obliterans (BXO) is a chronic inflammatory disease of unknown etiology that can affect the foreskin, glans, frenulum, meatus, and urethra [36]. The clinical appearance is usually easy to recognize, mostly being a severe phimosis with white sclerotic scarring of the prepuce (see Chap. 17) [5].

Apparently, the incidence of BXO in children has long been dramatically underestimated, being considered a rather rare event, an assumption being proven false by several recent studies [16]. A British group found histological confirmation of BXO in 12.1% of the boys referred to their clinic [51]; an earlier study from Hungary found BXO in 1,178 boys as often as in 40% of the cases [20].

A similar degree of underestimation appears to exist regarding the risk of penile cancer development in context with BXO. A prospective study found BXO in 28% of men operated for penile cancer [33].

After circumcision and confirmation of BXO, a close and long-term follow-up is needed as progression of the disease is possible, causing meatal stenosis in the short run and penile cancer in the long run. Topical application of tacrolimus ointment (off-label) shortly after surgery was shown to be a safe measure of preventing progression of the disease in 20 boys [11]. In light of the possible progress, the availability of preventive measures, and the possible malignant degeneration, it is advisable to always perform histological investigation of the tissue [5].

Recurrent balanitis/balanoposthitis is one of the rare medical indications for circumcision [25].

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