Balanitis xerotica obliterans complicating hypospadias repair

Kumar, Manoj; Harris, D.L.

doi:10.1054/bjps.1998.3017

Cited by 20 publications

(18 citation statements)

References 23 publications

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“…This results in recurrent severe stenosis and stricture and a difficult condition to manage. [1314] When local steroid injection fails, surgical excision of BXO lesion is recommended.…”

Section: Unfavourable Results Of Hypospadias Surgerymentioning

confidence: 99%

Unfavourable results in hypospadias

Agrawal

Misra

2013

Indian J Plast Surg

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Hypospadias urethroplasty is considered difficult as the complications and unfavourable results are not uncommon. At the turn of the century, due to a better understanding of applied anatomy of hypospadias, new techniques were developed which significantly brought down the complication rate. However unfavourable results are still disturbing. An algorithm for selection of surgery has been presented. Forty three secondary surgeries were performed over 3 years for correction of unfavourable results. The urethrocutaneous fistula was the most common (21%) followed by meatal stenosis (14%) and narrow neourethra (14%). Common unfavourable results have been discussed. On the basis of experience with a large number of hypospadias urethroplasty ‘tips to avoid or minimise unfavourable results’ have been presented. However, one should assess the final outcome of urethroplasty using hypospadias objective scoring evaluation.

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“…This results in recurrent severe stenosis and stricture and a difficult condition to manage. [1314] When local steroid injection fails, surgical excision of BXO lesion is recommended.…”

Section: Unfavourable Results Of Hypospadias Surgerymentioning

confidence: 99%

Unfavourable results in hypospadias

Agrawal

Misra

2013

Indian J Plast Surg

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“…97,98 Substitution urethroplasty with oral mucosa is mandatory in the presence of BXO. 98,99 Urethral diverticula Dilation of the neourethra (Figure 4), also known as megalourethra, has been described after the correction of proximal hypospadias, 100,101 although only for flap tube repairs. 44 It is unclear whether this complication is caused by an intrinsic lack of flap strength or by a subclinical or functional distal obstruction.…”

Section: Urethral Stricturementioning

confidence: 99%

Failed hypospadias in paediatric patients

et al. 2013

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| Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.

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“…The phenomenon of LS/BXO involving extragenital skin grafts used for genital reconstruction has been reported previously . Recently, Abdelbaky et al.…”

Section: Discussionmentioning

confidence: 70%

Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis

et al. 2013

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What's known on the subject? and What does the study add?• The European Association of Urology guidelines identify lichen sclerosus (LS) as a strong risk factor for penile squamous cell carcinoma (pSCC). However, this statement is based on the findings of case-control studies (Level of Evidence 2a) and a direct causal relationship between LS/balanitis xerotica obliterans (BXO) and pSCC remains to be established. Firm guidelines with respect to the appropriate follow-up policy for LS/BXO are lacking, whereas the impact of synchronous LS/BXO on the prognosis of pSCC remains to be determined.• The presence of histologically-confirmed synchronous LS/BXO in patients diagnosed with pSCC is relatively high, although it is not associated with an increased risk of adverse histopathological features. LS/BXO can develop in extragenital skin grafts used for reconstruction after organ-sparing surgery for pSCC. Objectives• To determine the rate of lichen sclerosus/balanitis xerotica obliterans (LS/BXO) in patients with penile squamous cell carcinoma (pSCC) and establish whether the presence of LS/BXO is associated with adverse histopathological features of pSCC.• To report the phenomenon of LS involving non-genital skin grafts in patients who underwent organ-sparing surgery and split-skin graft (SSG) reconstruction Patients and Methods• Between January 2002 and January 2010, 223 men underwent surgical treatment for pSCC. • A group of 52 patients with histologically-confirmed synchronous LS was identified (group A; overall rate of LS/BXO = 23.3%) and compared with a group of patients without synchronous LS (group B; n = 171; 76.7%).• A subgroup of patients who underwent surgical excision and SSG reconstruction was also identified • The histology reports of graft biopsies obtained during follow-up were reviewed and the rate of LS involving the graft was also recorded. Results• Mean (range) age at diagnosis was 60.9 (34-81) years and 60.7 (28-89) years for groups A and B, respectively (P = 0.958).• The mean (range) duration of follow-up was 38.3 (4-92) months for group A and 45.5 (4-107) months for group B (P = 0.162) • No statistically significant differences were noted between groups A and B in terms of tumour grade (P = 0.091), stage (P = 0.697), presence of lymphovascular invasion (P = 0.333), histological subtype (P = 0.107), associated carcinoma in situ (P = 0.246) or nodal status at initial diagnosis (P = 0.555).• In the subgroup of 188 patients who underwent SSG reconstruction, 41 (21.8%) patients had histologically-confirmed synchronous LS; in this subgroup, 26 (13.8%) patients underwent graft biopsy during follow-up.• Genital LS involving the graft was identified in seven specimens, although none of these seven cases had associated recurrent pSCC. Conclusions• The presence of histologically-confirmed synchronous LS in patients with pSCC is relatively high but is not associated with increased rates of adverse histopathological features, including carcinoma in situ.• LS can develop in extragenital skin grafts, although i...

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Balanitis xerotica obliterans complicating hypospadias repair

Cited by 20 publications

References 23 publications

Unfavourable results in hypospadias

Unfavourable results in hypospadias

Failed hypospadias in paediatric patients

Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis

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