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The surgical treatment of Balanitis Xerotica Obliterans.

Hartley A, Ramanathan C, Siddiqui H - Indian J Plast Surg (2011)

Bottom Line: Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group.Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases.In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom.

ABSTRACT

Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage.

Materials and methods: Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed.

Results: Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group.

Conclusions: Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

No MeSH data available.


Related in: MedlinePlus

Post-op I stage -stricture excised (a-d) grafted using buccal mucosa & II stage reconstruction (a1-d4)
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Figure 3: Post-op I stage -stricture excised (a-d) grafted using buccal mucosa & II stage reconstruction (a1-d4)

Mentions: In the group of 23 there were seven patients who had BXO affecting between three and five areas of their genitalia, indicating severe progressive disease. Of the four that had had previous surgery prior to referral to our unit, all had either release of adhesions or urethral/meatal dilatation. Reconstructive surgery with excision of the affected area and skin grafting or urethroplasty was performed for these patients and they are still being followed in the clinic. To date there is no recurrence of the disease and the patients have reported subjective improvement in their urinary and sexual function from before surgery. A patient in our study who had BXO affecting his meatus and urethra had undergone two optical urethrotomies and four urethral dilatations over a period of 12 years [Figure 2]. Due to the spread of the disease he needed to perform intermittent self-catheterisation twice a week to maintain a reasonable urinary flow for nearly ten years. We performed distal urethrotomy of the dense stricture to allow urethroscopy which also showed skip lesions of BXO in the posterior urethra. The patient underwent excision of the distal stricture and two-stage urethral reconstruction using a buccal mucosa graft [Figure 3]. Subsequently he was able to pass urine normally without the need for the self-catheterisation. At two years post procedure he remains disease-free.


The surgical treatment of Balanitis Xerotica Obliterans.

Hartley A, Ramanathan C, Siddiqui H - Indian J Plast Surg (2011)

Post-op I stage -stricture excised (a-d) grafted using buccal mucosa & II stage reconstruction (a1-d4)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111133&req=5

Figure 3: Post-op I stage -stricture excised (a-d) grafted using buccal mucosa & II stage reconstruction (a1-d4)
Mentions: In the group of 23 there were seven patients who had BXO affecting between three and five areas of their genitalia, indicating severe progressive disease. Of the four that had had previous surgery prior to referral to our unit, all had either release of adhesions or urethral/meatal dilatation. Reconstructive surgery with excision of the affected area and skin grafting or urethroplasty was performed for these patients and they are still being followed in the clinic. To date there is no recurrence of the disease and the patients have reported subjective improvement in their urinary and sexual function from before surgery. A patient in our study who had BXO affecting his meatus and urethra had undergone two optical urethrotomies and four urethral dilatations over a period of 12 years [Figure 2]. Due to the spread of the disease he needed to perform intermittent self-catheterisation twice a week to maintain a reasonable urinary flow for nearly ten years. We performed distal urethrotomy of the dense stricture to allow urethroscopy which also showed skip lesions of BXO in the posterior urethra. The patient underwent excision of the distal stricture and two-stage urethral reconstruction using a buccal mucosa graft [Figure 3]. Subsequently he was able to pass urine normally without the need for the self-catheterisation. At two years post procedure he remains disease-free.

Bottom Line: Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group.Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases.In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom.

ABSTRACT

Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage.

Materials and methods: Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed.

Results: Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group.

Conclusions: Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

No MeSH data available.


Related in: MedlinePlus