Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: The outcome of 1 and 2-stage techniques

Purpose: Balanitis xerotica obliterans (BXO) related strictures are complex and generally managed by 2-staged urethroplasty. We present our results with I-stage dorsal onlay and 2-stage buccal mucosal urethroplasty for such strictures. Materials and Methods: Between January 2000 and April 2004,39 patients, underwent buceal mucosal urethroplasty for BXO related anterior urethral strictures. The 25 patients with a salvageable urethral plate (group 1) were treated with 1-stage dorsal onlay urethroplasty- using a cosmetic incision. The 14 patients with a severely scarred urethral plate. focally dense segments or active infection (group 2) underwent 2-stage urethroplasty. Outcomes in terms of cosmetic appearance, stricture recurrence and complications in the 2 groups were assessed. Results: At a mean followup of 32.5 months (range 3 to D52) 3 patients, (12%) in group 1 had recurrent stricture, of which 2 and 1 were treated with optical urethrotomy and urethral dilation. respectively. All patients had a normal slit-like meatus and none had chordee or erectile., an dysfunction. Four group 2 patients (28.6%) required stomal revision and 2 had glans cleft. narrowing after stage 1 urethroplasty. Following stage 2, 3 patients had recurrent stricture. of whom 2 were treated with optical urethrotomy and 1 underwent repeat urethroplasty. Conclusions: In BXO related strictures with a viable urethral plate-l-stage dorsal onlay buccal mucosal urethroplasty provides excellent intermediate term results. The cosmetic incision described provides a normal, wide caliber, slit-like glans. Two-stage procedures provide satisfactory outcomes but they are associated with a higher revision rate.