BXO stands for BALANITIS XEROTICA OBLITERANS. It is another name for the skin disease LICHEN SCLEROSUS (LS), a condition that can also affect the female genitalia and occasionally other areas of the body.
The name BXO is only used when LS is affecting the male genitalia. It may sound like a rare and exotic disease, (and as yet we don’t know its aetiology), but BXO is actually a very common and under-diagnosed cause of genital problems.
These problems are often inappropriately managed because of failure to recognize, diagnose and understand the disease process.
BXO may develop at any time from childhood through to old age, though we most often see it for the first time in early adult life.
The most usual presentation is a progressive tightening of the foreskin (phimosis), usually associated with a characteristic white discoloration of the affected areas.
Sometimes adults first become aware of it because the diseased skin is prone to crack and split during sexual activity.
Whilst very mild or early BXO (particularly in children) may be controlled with strong steroid ointments, surgery currently offers the most effective solution.
A timely circumcision to remove the diseased foreskin is usually curative, particularly in the early stages (see section on circumcision).
If at circumcision there is any associated discoloration affecting the glans, this will often fade away or improve over time.
If however the phimosis is ignored and the disease becomes more advanced, then the resulting inflammation and scarring may cause the foreskin and glans to weld together, so that only an experienced reconstructive surgeon can adequately remove the adherent foreskin.
In rare cases it may even be necessary to completely resurface a scarred, ulcerated glans with a graft of healthy new skin.
A fairly common complication of BXO is for disease on the glans to spread into the urethral opening (meatus), leading to progressive narrowing and spraying of the urinary stream.
Left untreated, the disease can continue to spread down the urethra to cause extensive stricturing and obstruction to the urinary stream.
Conventional urological treatment with dilatations and internal ‘telescopic’ procedures can only provide temporary relief, while allowing the disease to continue spreading further down the urethra.
Unfortunately urologists who do not fully understand the condition may suggest continuing long-term with dilatations as and when required.
This is a truly bad idea because established BXO strictures can only be effectively treated by specialized surgery to replace the diseased segment of urethra with healthy new lining taken from inside the mouth (see section on strictures).
The longer that definitive treatment is delayed, the more extensive and difficult the eventually inevitable reconstructive surgery will be.
The most serious potential complication of BXO is the risk of progression to penile cancer (see section on penile cancer).
Fortunately this only tends to occur in chronic neglected BXO that has been left untreated for many years.