Partially Obstructed Urethral Strictures Due to Balanitis Xerotica Obliterans Improved by the Use of Topical Tacrolimus: Experience at a Tertiary Care Centre

Introduction Balanitis xerotica obliterans (BXO) can cause phimosis, meatal stenosis, and urethral strictures. However, management of these conditions in BXO patients is difficult. Surgical interventions, with their own risks and complications, demonstrate higher rates of disease recurrence. Recently, topical applications of steroids and immunomodulators have been evaluated for their role in the management of urethral strictures associated with BXO. In this study, we evaluated the role of topical application of tacrolimus in urethral strictures associated with BXO. Materials and methods This was a prospective study on male patients having urethral strictures associated with BXO. Patients were thoroughly evaluated and advised topical application of 0.1% tacrolimus. They were then reevaluated at six weeks. If the effects of tacrolimus were found to be satisfactory, then patients were advised to continue this treatment for three months. After three months, the patients were again evaluated. At the time of each reevaluation, changes in uroflowmetry and International Prostate Symptom Score (IPSS) were noted. Results A total of 53 patients were included in this study. The mean values of pre- and post-tacrolimus maximum urinary flow rate on uroflowmetry(Q_max) were 12.00±1.43 m/s and 15.26±3.14 m/s, respectively (p<0.001). The mean values of pre- and post-tacrolimus IPSS scores were 18.55±2.28 and 13.04±4.72, respectively (p<0.001). Based on the results, the application of tacrolimus was found to be ineffective in those with strictures >2 cm in length. Of the 53 patients included in the study, 21 required surgical intervention, as their response to tacrolimus was unsatisfactory. Conclusion Topical application of tacrolimus is a safe and feasible treatment option for short-segment (≤2cm) urethral strictures associated with BXO.