Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair

Mohamed Sultan, Mohamed El-Shazly, Eid Elsherif, Sheren Younes, Mohamed Selim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives To evaluate the presence of balanitis xerotica obliterans (BXO), clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methods Between February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. Results In all, 157 boys were enrolled in our study, with a mean (SD) age of 6.4 (2.8) years. All the boys had a history of failed hypospadias repair surgeries (once or more). The presentation was fistula in 34 boys (21.7%), meatal stenosis in 45 (28.7%), urethral stricture in 28 (17.8%), and total dehiscence in 50 (31.8%). BXO was detected clinically in 46 boys (29.3%). The total number of biopsies taken was 314, of which 124 (39.5%) were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5%), meatal stenosis in 18 (10.8%), urethral stricture in seven (4.5%), and total dehiscence in 15 (9.6%). Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4%), meatal stenosis in 40 (12.7%), urethral stricture in 22 (7%), and total dehiscence in 42 (13.4%). Conclusions In failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair.

Original languageEnglish
Pages (from-to)326-330
Number of pages5
JournalArab Journal of Urology
Volume15
Issue number4
DOIs
Publication statusPublished - 1 Dec 2017

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Balanitis Xerotica Obliterans
Hypospadias
Biopsy
Urethral Stricture
Pathologic Constriction
Fistula
Urethra
Hematoxylin
Eosine Yellowish-(YS)
Informed Consent

Keywords

  • Balanitis xerotica obliterans
  • Hypospadias
  • Lichen sclerosus

Cite this

@article{5005de32f65746fd82164210656cb33f,
title = "Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair",
abstract = "Objectives To evaluate the presence of balanitis xerotica obliterans (BXO), clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methods Between February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. Results In all, 157 boys were enrolled in our study, with a mean (SD) age of 6.4 (2.8) years. All the boys had a history of failed hypospadias repair surgeries (once or more). The presentation was fistula in 34 boys (21.7{\%}), meatal stenosis in 45 (28.7{\%}), urethral stricture in 28 (17.8{\%}), and total dehiscence in 50 (31.8{\%}). BXO was detected clinically in 46 boys (29.3{\%}). The total number of biopsies taken was 314, of which 124 (39.5{\%}) were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5{\%}), meatal stenosis in 18 (10.8{\%}), urethral stricture in seven (4.5{\%}), and total dehiscence in 15 (9.6{\%}). Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4{\%}), meatal stenosis in 40 (12.7{\%}), urethral stricture in 22 (7{\%}), and total dehiscence in 42 (13.4{\%}). Conclusions In failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair.",
keywords = "Balanitis xerotica obliterans, Hypospadias, Lichen sclerosus",
author = "Mohamed Sultan and Mohamed El-Shazly and Eid Elsherif and Sheren Younes and Mohamed Selim",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.aju.2017.08.002",
language = "English",
volume = "15",
pages = "326--330",
journal = "Arab Journal of Urology",
issn = "2090-598X",
publisher = "Elsevier BV",
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Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair. / Sultan, Mohamed; El-Shazly, Mohamed; Elsherif, Eid; Younes, Sheren; Selim, Mohamed.

In: Arab Journal of Urology, Vol. 15, No. 4, 01.12.2017, p. 326-330.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair

AU - Sultan, Mohamed

AU - El-Shazly, Mohamed

AU - Elsherif, Eid

AU - Younes, Sheren

AU - Selim, Mohamed

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objectives To evaluate the presence of balanitis xerotica obliterans (BXO), clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methods Between February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. Results In all, 157 boys were enrolled in our study, with a mean (SD) age of 6.4 (2.8) years. All the boys had a history of failed hypospadias repair surgeries (once or more). The presentation was fistula in 34 boys (21.7%), meatal stenosis in 45 (28.7%), urethral stricture in 28 (17.8%), and total dehiscence in 50 (31.8%). BXO was detected clinically in 46 boys (29.3%). The total number of biopsies taken was 314, of which 124 (39.5%) were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5%), meatal stenosis in 18 (10.8%), urethral stricture in seven (4.5%), and total dehiscence in 15 (9.6%). Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4%), meatal stenosis in 40 (12.7%), urethral stricture in 22 (7%), and total dehiscence in 42 (13.4%). Conclusions In failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair.

AB - Objectives To evaluate the presence of balanitis xerotica obliterans (BXO), clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methods Between February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. Results In all, 157 boys were enrolled in our study, with a mean (SD) age of 6.4 (2.8) years. All the boys had a history of failed hypospadias repair surgeries (once or more). The presentation was fistula in 34 boys (21.7%), meatal stenosis in 45 (28.7%), urethral stricture in 28 (17.8%), and total dehiscence in 50 (31.8%). BXO was detected clinically in 46 boys (29.3%). The total number of biopsies taken was 314, of which 124 (39.5%) were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5%), meatal stenosis in 18 (10.8%), urethral stricture in seven (4.5%), and total dehiscence in 15 (9.6%). Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4%), meatal stenosis in 40 (12.7%), urethral stricture in 22 (7%), and total dehiscence in 42 (13.4%). Conclusions In failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair.

KW - Balanitis xerotica obliterans

KW - Hypospadias

KW - Lichen sclerosus

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DO - 10.1016/j.aju.2017.08.002

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