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: BXO, balanitis xerotica obliterans; Balanitis xerotica obliterans; H&E, haematoxylin and eosin; Hypospadias; Lichen sclerosus.

Fig. 1

H&E image showing epidermal atrophy and orthokeratotic hyperkeratosis, showing basal cell vacuolisation, clefting of dermal-epithelial junction; dermis shows dense collagenisation and lymphocytic infiltrate (×200).

Fig. 2

H&E image showing atrophic epidermis with loss of rete ridges, dermal hyalinisation, thickened basement membrane and marked dermal collagenisation (×200).