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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

BXO involving glans and corona (a3-d3) excised and resurfaced with split skin graft (a4-d4)
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Figure 6: BXO involving glans and corona (a3-d3) excised and resurfaced with split skin graft (a4-d4)

Mentions: However, four patients underwent a two-stage urethroplasty with buccal mucosal reconstruction, two patients had urethral tubularisations and one had an optical urethrotomy. The remainder had excision of the affected skin and grafting [an example shown in Figure 6] or meatal reconstruction. Early results showed that 100% of these patients had a subjective improvement in urinary or sexual function following plastic surgery input. One hundred percent patients had no recurrence of the disease after treatment in our unit although 13% had BXO still visible but not advancing. Patients were followed up for an average of two years and five months prior to discharge.


The surgical treatment of Balanitis Xerotica Obliterans.

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

BXO involving glans and corona (a3-d3) excised and resurfaced with split skin graft (a4-d4)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: BXO involving glans and corona (a3-d3) excised and resurfaced with split skin graft (a4-d4)
Mentions: However, four patients underwent a two-stage urethroplasty with buccal mucosal reconstruction, two patients had urethral tubularisations and one had an optical urethrotomy. The remainder had excision of the affected skin and grafting [an example shown in Figure 6] or meatal reconstruction. Early results showed that 100% of these patients had a subjective improvement in urinary or sexual function following plastic surgery input. One hundred percent patients had no recurrence of the disease after treatment in our unit although 13% had BXO still visible but not advancing. Patients were followed up for an average of two years and five months prior to discharge.

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