There has been a recent increase in strictures associated with balanitis xerotica obliterans (BXO), which are more like inflammatory strictures than isolated, traumatically induced scars. BXO usually begins with inflammation of the glans and generally leads to meatal stenosis, if not a true stricture of the fossa navicularis. Although the cause of this distal penile skin and urethral inflammation is unknown, recent literature suggests the possibility of bacterial infection with resultant skin changes. There is also some evidence that the progression of the stricture to eventually involve the entire anterior urethra may be caused by high-pressure voiding that leads to intrava-sation of urine into the glands of Littre, inflammation of these glands, and micro abscesses and deep spongi-ofibrosis (O Fig. 8.2). Whether the urethral changes and fibrosis are also related to bacterial injury has not been well defined.
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