A white, inflammatory scaring condition called BXO can also develop in congenital tight foreskin in adults.

The Association Between Phimosis and Balanitis Xerotica Obliterans (BXO) 

Phimosis, a condition characterised by the tightening of the foreskin, leading to difficulty in retracting it over the head of the penis, can appear at birth (congenital) or later in adult life (acquired). This blog also discussed the correlation between acquired tight foreskin and balanitis xerotica obliterans (BXO), also known as lichen sclerosus et atrophicus, a chronic inflammatory condition primarily affecting the genital area. 

Correlation Analysis of Phimosis and BXO: Notably, the association between acquired phimosis and BXO is more pronounced than congenital phimosis. BXO is identified as the primary causative factor for acquired phimosis in both adults and children. The inflammatory nature of BXO triggers scarring and constriction of the foreskin, consequently resulting in diseased and acquired phimosis. While the relationship between congenital phimosis and BXO is less explicit, BXO can also be present in cases of congenital phimosis. 

Significance and Treatment Modalities: The heightened risk of BXO linked to acquired phimosis underscores the critical importance of timely diagnosis and effective management. Early intervention for BXO is paramount in averting complications such as extensive scarring and urethral stricture. 

Treatment approaches vary based on severity and aetiology. In milder instances of acquired phimosis, topical corticosteroids and non-surgical interventions may be required. Surgical intervention, particularly circumcision, may be warranted in severe cases of phimosis or BXO, particularly when they pose significant discomfort, impede hygiene, or disrupt sexual function. 

Recent Study on BXO and Phimosis: A contemporary study sought to enhance our understanding of the correlation between BXO and phimosis. Histological analysis of tissue samples from 120 subjects who underwent circumcision for phimosis was conducted. Findings revealed a substantial presence of BXO, with 45.1% of subjects with congenital phimosis and 62.3% with acquired phimosis manifesting BXO. This data strongly indicates a robust association between BXO and acquired phimosis. 

Key message: The study distinctly underscores a robust correlation between BXO and acquired phimosis. Notably, the type of phimosis (congenital or acquired) emerged as the pivotal factor linked to BXO development in this investigation. Nevertheless, further research is warranted to validate and fortify these observations. 

Consultation with our Urological Specialist: Individuals faced with challenges retracting the foreskin are advised to seek consultation with our consultant urologists for precise diagnosis and tailored treatment options. 

Note: This blog is intended solely to serve an informative function and should not be taken as medical professional advice. For specific concerns, it is imperative to use the expertise of our consultant urologists.

Cuts or tears of foreskin

Cuts and Tears in the Foreskin: Causes, Treatment and When to See a Doctor

The foreskin in men is delicate and prone to minor cuts or tears during sexual activities. While these cuts usually heal within a week, knowing their cause, how to care for them, and when to seek specialist urologist advice are essential. Possible causes of foreskin cuts or tears include rough sex, tight foreskin, diabetic complications, skin lesions like lichen sclerosis (BXO), STDs, and fungal infections. Treatment options include simple care, medications, controlling underlying conditions, and surgery, e.g. circumcision or preputioplasty in some cases.

This blog will explore the potential causes of foreskin cuts or tears, treatment options, and when to see a specialist.

Causes of Foreskin Cuts or Tears

Rough Sex

Friction during sexual activity can cause minor tears. While these minor cuts usually heal within a week, it is essential to know how to care for them in case you have some medical conditions.

Tight Foreskin

A condition called phimosis can make it difficult to retract the foreskin over the head of the penis, leading to tearing during retraction.

Diabetic Complications

Poorly controlled diabetes can decrease blood flow and slow healing, making the foreskin more susceptible to cuts and infections. The repeated infection will require prompt treatment, and tight freoskin will require circumcision in diabetes.

Skin Lesions

Eczema, Balanitis Xerotica Obliterans (BXO) or other skin conditions on the foreskin can cause cuts or tears.

Balanitis

Balanitis is an infection and swelling of the foreskin and the tip of the penis (called the glans penis). Balanoposthitis is called a more severe infection of the head of the penis along with the foreskin.

Sexually Transmitted Diseases (STDs)

Certain STDs can cause sores or ulcers on the penis, including the foreskin.

Fungal Infections

Yeast infections can irritate and inflame the foreskin, making it more prone to tearing.

Treatment Options

Simple Care

For minor cuts, gentle cleansing with warm water and a saline solution, followed by applying petroleum jelly or lubricant, can promote healing.

Medical treatment

Depending on the cause, your doctor might prescribe:

• Antifungal creams for fungal infections.

• Antibiotic creams to prevent bacterial infections.

• Steroid creams to reduce inflammation in early BXO

Controlling Underlying Conditions

If diabetes or an STD is the culprit, managing those conditions can help prevent future cuts and promote healing.

Surgical Options

In some cases, surgery might be necessary. Here are some potential procedures:

• The Dorsal Slit

A small incision was made on the upper side of the foreskin to relieve tightness and prevent future tearing.

• Preputioplasty

Preputioplasty repositions the foreskin to allow for easier retraction and reduce the risk of tears.

• Circumcision

Complete or partial removal of the foreskin.

• Biopsy

Sometimes, a small tissue sample might be taken to rule out more serious conditions or BXO.

Post-Operative Care:

Following surgery, your doctor will provide specific instructions on wound care, pain management, and follow-up appointments after circumcision or other procedures. This might include using steroid creams to reduce inflammation in BXO and monitoring for signs of recurrence of BXO on different parts of the penis.

When to See a Urologist

See our specialist if you experience any of the following:

*  Severe pain or bleeding

*  Signs of infection, such as redness, swelling, pus, or fever

*  Difficulty urinating

*  The cut doesn't heal within a week

*  The foreskin is exceptionally tight

*  You suspect an STD

Conclusion

Most foreskin cuts heal with simple care. However, seeking medical attention is crucial if you experience any concerning symptoms. Early diagnosis and treatment can prevent complications and ensure a speedy recovery.

Disclaimer

This blog is for informational purposes only and should not be a substitute for professional medical advice. Always consult with our consultant urologist for diagnosis and treatment.

Foreskin problems

Understanding Foreskin Problems: Causes, Signs, and Treatment

The foreskin, a protective fold of skin covering the penis in uncircumcised individuals, requires proper care to prevent potential issues later in life. Here's a comprehensive guide to foreskin problems, their causes, signs, treatment, and preventive measures.

What is the Foreskin?

The foreskin is a layered fold of skin that shields the end of the penis in uncircumcised individuals. While it requires no special care in early childhood, attention to hygiene becomes crucial as one grows older to prevent problems like swelling, infection, tightness, irritation, and dryness.

Causes of Foreskin Problems:

In young children, the foreskin is naturally attached to the penis head by the synechia membrane, which dissolves over time. Forcing it back prematurely can lead to issues. Phimosis, where the foreskin is too tight, is another cause, usually resolving between ages two and six. STIs, infections, BXO (lichen sclerosis ) or injuries can trigger problems in teenagers and adults.

Signs of Foreskin Problems:

Look out for pain during urination, itchiness, inability to retract the foreskin, pain during intercourse, redness, soreness, swelling, dryness, or split and bleeding skin. Consult our specialist Urologist if you experience these symptoms.

Treatment for Foreskin Problems:

Treatment varies based on the issue. Dryness may be managed with creams or ointments like steroid cream, while infections like balanitis can be treated with medications. In some cases, procedures may be required, such as moving back the foreskin in children with phimosis or circumcision in adults with persistent issues. Our approach with circumcision with glue is the best option.

Prevention of Foreskin Problems:

Proper care is crucial. Change underwear regularly, opt for loose underwear, avoid heavily scented hygiene products, clean the foreskin daily with warm water, and use protection during sex to reduce STI risks.

Specialists for Foreskin Problems:

A urologist, or a pediatric urologist for children, is the specialist to consult for foreskin problems. We provide these services in the London Circumcision Centre.

When to Consider Circumcision:

Circumcision is only considered when foreskin problems are severe and impact daily life, causing persistent pain or frequent urination issues. Phimosis with a scared or cracked foreskin will require circumcision.

When to Seek Medical Advice:

Call us if you experience difficulty urinating, a burning sensation, increasing pain, or inability to return the foreskin to its original position.

Understanding and addressing foreskin problems early is essential for maintaining male reproductive health. Regular hygiene practices and prompt medical attention can make a significant difference in preventing and managing foreskin-related issues.

Jet injection without needle local anaesthesia in adults’ and children's circumcision - recent study

Circumcision: Exploring Different Approaches for Adults and Boys for local anaesthesia

Circumcision is a practice that is often carried out for religious, traditional, and medical reasons. In our country, most men undergo circumcision, and most of these procedures are performed using local anaesthesia. Since circumcision is primarily performed for religious purposes, families typically want their children to know the procedure. Therefore, the preschool period is often chosen as the ideal age for circumcision in Turkey. However, circumcisions performed during this stage, when a child discovers their sexual identity, can negatively affect psychosexual development.

Additionally, using a needle for local anaesthetic injections can significantly increase anxiety in children. Despite the use of topical anaesthetic creams to reduce stress, needle phobia remains unresolved. Research indicates that 63% of children in the USA are afraid of needles.

Needle phobia is a concern for children and adult patients in circumcision procedures. To address this issue, some studies have explored using needle-free jet injectors. For example, Peng et al. found that a no-needle jet injector technique was safe, effective, and well-tolerated for adult circumcision. Similarly, jet injectors have been used in urology practice, such as vasectomy procedures, with high patient acceptance rates. However, the literature has conflicting opinions regarding the pain associated with jet injector injections compared to conventional needle injections.

In urology, jet injectors have been used for intracavernosal alprostadil injections in patients with erectile dysfunction. However, studies have shown that the procedure is more painful and less effective than the conventional needle method, leading patients to prefer the latter. This study aimed to evaluate the effectiveness of jet injector anaesthesia in children who reject needle injections during circumcisions performed under local anaesthesia. However, we observed that local anaesthetic injection with a jet injector did not provide sufficient pain relief for a comfortable circumcision.

The epidermis, the outer layer of the skin, varies in thickness across different parts of the body. For instance, the thickness of the epidermis on the eyelid is 0.04 mm, while it can reach up to 1.6 mm on the palm. The dorsal part of the penis has a thicker epidermis than the ventral surface, which can affect the penetration of the anaesthetic agent when using jet injectors. Injections on the ventral surface may pose a risk of urethral injuries due to the thinner epidermis in that area.

Several parameters are crucial for jet injectors, including thrust pressure, contact pressure, drug volume per shot, nozzle opening, and the distance from the nozzle tip to the skin surface. For small operations, the recommended anaesthetic dose delivered with a jet injector is 0.07-0.1 ml per spurt, with a nozzle diameter of 0.1 mm and an application pressure of 130-160 psi. However, studies have shown that increasing the nozzle diameter may result in deeper penetration and increased pain. Using newer-generation jet injectors with lower pressure has been demonstrated to achieve the same penetration depth with less pain.

In this recent study, consistent with findings in the literature, injection with a jet injector without a needle was better tolerated than the conventional needle method. However, the time for local numbness was long, and the amount of anaesthetic agent used was lower in the jet injector group. However, the FLACC scores (a pain assessment tool) measured during circumcision were higher in the jet injector group, and additional anaesthetic medication was needed for circumcision in children and adults. 

We provide a service for needless anaesthesia with some additional fees for needle-phobic adults and children. 

Please get in touch with us for further details. 

“We provide without needle local anaesthesia in our clinic ”

— https://doi.org/10.1080/08941939.2020.1817635