title: Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans.
abstract: BACKGROUND
  We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period.
  
  
  METHODS
  Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes.
  
  
  RESULTS
  One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034).
  
  
  CONCLUSIONS
  Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.
authors.affiliation: Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, UK. d.wilkinson@liv.ac.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilkinson
authors.forename: Nick
authors.initials: N
authors.lastname: Lansdale
authors.forename: Lucy H
authors.initials: LH
authors.lastname: Everitt
authors.forename: Sean S
authors.initials: SS
authors.lastname: Marven
authors.forename: Jenny
authors.initials: J
authors.lastname: Walker
authors.forename: Rang N
authors.initials: RN
authors.lastname: Shawis
authors.forename: J P
authors.initials: JP
authors.lastname: Roberts
authors.forename: A E
authors.initials: AE
authors.lastname: Mackinnon
authors.forename: P P
authors.initials: PP
authors.lastname: Godbole
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D052798:Balanitis Xerotica Obliterans / Q000628:therapy*; D002648:Child; D002944:Circumcision, Male; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D014221:Triamcinolone