Perineostomy: the last oportunity

Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis. .

Balanitis xerótica obliterante: ¿una amenaza permanente? / Obliterant xerotic balanitis, a permanent threat?

La balanitis xerótica obliterante (BXO) es una enfermedad inflamatoria crónica con una incidencia reportada de 10-40 por ciento de las fimosis en la infancia, cuyo diagnóstico va en aumento, posiblemente debido a una mayor sospecha. El objetivo de nuestro estudio es analizar los casos de BXO tratados en nuestro centro y su evolución. Revisión retrospectiva entre los años 2002 y 2012 de pacientes con diagnóstico de BXO confirmado por anatomía patológica. Se analizan datos demográficos, tratamiento médico y quirúrgico, y complicaciones post-operatorias. Se estudió retrospectivamente 26 biopsias con diagnóstico histopatológico de BXO. La edad promedio al momento de la circuncisión fue de 7,5 años (r 6m–15a, mediana 9,5). 16/26 pacientes fueron operados por urólogo infantil, y 10/26 por cirujano infantil. En relación a patologías asociadas, uno tenía una hipospadias, y otro un reflujo vesico-ureteral. Después del procedimiento, 6 pacientes recibieron corticoides tópicos. Dos pacientes presentaron estenosis del meato diagnosticado intra-cirugía que se manejan con dilataciones. Cinco pacientes tuvieron re-estenosis del prepucio, los que fueron sometidos a una segunda cirugía; todos habían sido operados por cirujano infantil inicialmente. El tiempo promedio total de seguimiento fue de 6,9 meses (r 1-36); sin embargo de los pacientes sin re-operación (21/26), el seguimiento promedio por urólogo fue de 7,3 meses y aquellos por cirujano infantil fue de 1,8 meses. En nuestro centro, el diagnóstico de BXO por anatomía patológica sólo se hace ante la sospecha clínica, ya que no todas las fimosis son estudiadas con biopsia; esto impide estimar su real incidencia. En esta serie, en los pacientes donde se realizó circuncisión total (80 por ciento), este fue el tratamiento definitivo sin complicaciones, a pesar que sólo el 23 por ciento de los pacientes recibieron corticoides tópicos post tratamiento...

Xerotic Balanitis (BXO) is a chronic inflammatory disease with a reported 10-40 percent of phimosis incidence in childhood, whose diagnosis is increasing, possibly due to greater suspicion. The aim of our study was to analyze cases of BXO treated in our center and its evolution. MATERIAL AND METHODS: Retrospective review between 2002 and 2012 of patients diagnosed with pathologically proven BXO. Demographics, medical and surgical treatment, and postoperative complications were analyzed. RESULTS: We retrospectively studied 26 biopsies with histopathological diagnosis of BXO. The average age at circumcision was 7.5 years (r 6m-15a, median 9.5). 16/26 of the patients were operated by pediatric urologists, and 10/26 by pediatric surgeons. Regarding comorbidities, one had a hypospadias, and one a vesicoureteral reflux.After the procedure, 6 patients received topical corticosteroids. Two patients had meatal stenosis diagnosed intra-operatively handled with dilations. Five patients had re-stenosis of the foreskin, which underwent a second surgery; pediatric surgeons initially operated all of them. Mean follow-up was 6.9 months (range 1-36), but between patients without re-operation (21/26), the average follow-up was 7.3 months when done by urologist and for those done by pediatric surgeon it was 1.8 months. CONCLUSIONS: In our center, the diagnosis of BXO by antomopathology is done only after clinical suspicion, because not all phimosis are studied with biopsy, for this reason we are unable to estimate its actual incidence. In this series, in all patients where complete circumcision (80 percent) was performed, this was the definitive treatment without complications, even though only 23 percent of patients received topical corticosteroids after treatment. Because little is known about BXO and it has possible future complications, we believe that its management and long-term monitoring should performed by a specialist.