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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

Algorithm for the management of Balanitis Xerotica Obliterans
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Figure 7: Algorithm for the management of Balanitis Xerotica Obliterans

Mentions: Although our case series is small we think our results show the importance of early recognition of unresolved, progressive and recurrent BXO cases. Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases.[1] The progression of the BXO disease gets arrested following circumcision by removing the urine-rich environment and patients with meatal or urethral disease are most likely to require excision and/or reconstruction for a long-lasting cure. Suitable cases should be referred to specialised units for further assessment and surgical management by excision and/or reconstruction for a disease that is prevalent in the male population. An algorithm on the management protocol has been presented [Figure 7].


The surgical treatment of Balanitis Xerotica Obliterans.

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

Algorithm for the management of Balanitis Xerotica Obliterans
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Algorithm for the management of Balanitis Xerotica Obliterans
Mentions: Although our case series is small we think our results show the importance of early recognition of unresolved, progressive and recurrent BXO cases. Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases.[1] The progression of the BXO disease gets arrested following circumcision by removing the urine-rich environment and patients with meatal or urethral disease are most likely to require excision and/or reconstruction for a long-lasting cure. Suitable cases should be referred to specialised units for further assessment and surgical management by excision and/or reconstruction for a disease that is prevalent in the male population. An algorithm on the management protocol has been presented [Figure 7].

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