Challenging Penile Reconstruction in Adult Balanitis Xerotica Obliterans with Near-total Glans Fibrosis

Balanitis xerotica obliterans (BXO), the genital manifestation of lichen sclerosus, is a chronic inflammatory dermatosis that may cause progressive sclerosis and anatomical distortion. This case report presents a 58-year-old male with a 2-year history of penile deformity, circumferential hypopigmentation of the glans, sexual discomfort, and lower urinary tract symptoms. Initial assessment showed an International Prostate Symptom Score (IPSS) of 17 and an International Index of Erectile Function-5 (IIEF-5) score of 12. Physical examination revealed circumferential fibrosis with obliteration of the sulcus coronarius and destruction of approximately 70% of glans architecture, while the urethral meatus remained patent. Following excision of fibrotic tissue and penile mobilization, reconstruction was performed using a split-thickness skin graft (STSG) for a 3 cm × 5 cm circumferential defect. At 42-day follow-up, IPSS improved to 8 and IIEF-5–14. Advanced BXO may require reconstructive surgery, with STSG providing satisfactory functional and cosmetic outcomes.