Topical plus systemic testosterone speeds response in BXO

Following traditional surgical procedures with topical and systemic testosterone therapy may have a profound effect onrecovery from balanitis xerotica obliterans (BXO), according to a study presented by Charles L. Secrest, MD, of theMississippi Urology Clinic in Jackson.

"The improvements can be dramatic. Even the advanced cases have had near normalization of the glans, meatus, and prepuce withboth topical and systemic replacement of testosterone," Dr. Secrest told colleagues attending this year's AUA annual meetinghere.

BXO is a relatively rare disease striking only six in 1,000 men. Complications include meatal stenosis and urethralstrictures. Standard treatment is a two-stage surgical procedure. There is no definitive medical treatment. Varying degrees ofsuccess have been reported with topical therapies incorporating corticosteroids or tacrolimus (Prograf). There is very littlein the literature concerning the use of topical steroids, and apparently no studies involving systemic steroid therapy.

Dr. Secrest told Urology Times that combining systemic and topical testosterone seemed to be an obvious avenue topursue. He noted that the symptomatology displayed by the BXO patients was similar to that seen in men withhypogonadism.

"My thoughts were that if topical testosterone therapy had an effect on BXO, maybe systemic testosterone would work as well.Many of these men exhibited symptoms associated with hypogonadism," Dr. Secrest said.

Dr. Secrest was able to obtain serum samples from 27 of 59 patients in the trial. Twenty-one of these patients were found tohave testosterone levels

His study is continuing, and systemic testosterone (oral or intramuscular injection) combined with topical testosterone is nowthe standard of care at his clinic, he said.