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S27-12
(P)
SINGLE-STAGE URETHROPLASTY WITH BUCCAL MUCOSAL INLAY GRAFT FOR
STRICTURE DUE TO BALANITIS XEROTICA OBLITERANS IN BOYS
Charlotte WETHERILL, Alexander TURNER and Ramnath SUBRAMANIAM
Leeds Children's Hospital, Department of Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE
Balanitis Xerotica Obliterans (BXO) is a common foreskin pathology but in severe cases affects urethra causing stricture
with sequelae including bladder dysfunction and upper tract compromise. Repeated urethral dilatation or steroid therapy
temporizes definitive surgical management. We present data from our prospective study using single-stage buccal
mucosal inlay graft (BMIG) following stricturectomy.
PATIENTS AND METHODS
Five patients with histologically proven urethral BXO were identified. Pre-operative uroflowmetry measurements were
taken, including flow rates and voiding duration. The same surgeon performed the procedure in all patients. Cystoscopy
confirmed the location of the stricture. The stricture was excised to expose tunica albuginaea. BMG was harvested,
prepared and placed as an inlay graft and sutured to the native urethra. The urethra was tubularised around a Ch12
Foley catheter and a cystotomy button placed. Uroflowmetry was repeated after 2,4 and 6 months post-operatively.
Student’s t-test was used to compare mean values.
RESULTS
Median age at time of BMIG urethroplasty was 13 years 5 months (range 10yr 7mo-17yr 8mo); median follow-up of
seven months (range 2-11mo). All the boys had a successful outcome; mean maximum urinary flow rate improved
significantly from 4.2ml/s to 26ml/s (p=0.0002). Voiding time reduced from 65.2 to 15.8 seconds (p=0.0012) with no
significant change in voided volume. The table below shows the results obtained. One boy has a fistula in distal penis,
awaiting closure but has good stream from tip.
Pre-BMIG (mean) Post-BMIG (mean) p value
Max flow rate (ml/s)
4.2
26
0.0002
Mean flow rate (ml/s)
1.6
12.2
0.0023
Time to max flow (s)
23.4
5.6
0.224
Total voiding time (s)
65.2
15.8
0.0012
Total volume voided
(ml)
151.8
197.4
0.4139
CONCLUSIONS
We show that single-stage BMIG placement is successful, resulting in excellent functional results.