Sathish Kumar G, Haris C. H, Shanky Singh, Vaibhav Vikas, Jatin Soni
BACKGROUND
Balanitis Xerotica Obliterans (BXO), also known as lichen sclerosus of penis is a chronic, progressive disease of the glans and prepuce that leads to phimosis and stricture of the urethra that can extend from the meatus and glanular urethra to the prostatic urethra. Urinary and sexual functions are affected and there is a severe reduction in quality of life. Many patients have been initially treated with tacrolimus or circumcision, when the disease has involved the prepuce and glans superficially, but conservative management has a limited role in this condition. Once stricture develops, surgical intervention in the form of grafts or flaps becomes necessary. We present our results with single-stage Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) based on tunica vaginalis flap for BXO related strictures of meatus and fossa navicularis.
MATERIALS AND METHODS
From July 2014, six patients who underwent single stage Ventral Onlay Buccal Mucosal Graft Urethroplasty Graft (VOBMGU) based on tunica vaginalis flap for BXO related strictures of urethral meatus and navicular fossa were included in the study. Patients presenting with BXO were clinically assessed for the extent of involvement as having BXO affecting the foreskin, glans, meatus, penile shaft, urethra and scrotum. They were radiologically assessed with a retrograde urethrogram and ultrasound abdomen. Outcome was assessed in terms of uroflowmetry, cosmetic appearance, stricture recurrence and complications.
RESULTS
Patients were reviewed every three months for over one year and six monthly. Only one patient had mild stenosis of the urethral meatus, as evidenced by change in flow, which was treated successfully with dilatation. One patient reported moderate splaying of urine, but this was mild in all other cases. All patients had a normal slit-like meatus, satisfactory voiding and sexual functions.
CONCLUSION
Isolated involvement of fossa navicularis and meatal stenosis stricture due to BXO can be treated with Ventral Onlay Buccal Mucosal Graft Urethroplasty (VOBMGU) based on tunica vaginalis flap especially in cases where the glans appeared unhealthy and compromised vascularity. It provides good short-term results with various advantages of tunica vaginalis like easy harvestability, close proximity to the penis, high vascularity and good support to BMG graft.
