Abstract
Introduction
Lichen sclerosus (LS) is a common cause of urethral stricture disease. The purpose of this article is to review the literature over the past 5 years, to describe current treatment of lichen sclerosus as it relates to urethral stricture in men.
Materials and methods
Literature reviews were performed using PUBMED, with search terms “lichen scleros*” and “urethral stenosis”, as well as “lichen scleros*” and “urethral stricture”. Relevant articles published within the past 5 years were selected for review. A summary of current treatment of lichen sclerosus was prepared and synthesized.
Results
For LS affecting genital skin, topical steroids are a mainstay of therapy but in advanced cases, surgery may be required such as circumcision. When LS causes urethral stricture, urethral dilatation is unlikely to be successful long term, and surgery is often required, such as meatoplasty, single- or two-stage urethroplasty, or perineal urethrostomy. Oral mucosal grafting is the graft of choice, and usage of genital skin for flaps or grafts is best avoided due to predilection for recurrence. Biopsy and long-term surveillance of LS are recommended, due to its potential association with squamous cell carcinoma development.
Conclusion
Although debate still exists regarding the pathogenesis of LS, it is agreed that LS can pose a treatment challenge to physicians and surgeons. Treatment options for LS range from pharmacological to surgical, depending on severity and location of disease, patient factors, and response of previous treatments.
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References
Stewart L, McCammon K, Metro M, Virasoro R (2014) SIU/ICUD consultation on urethral strictures: anterior urethra-lichen sclerosus. Urology 83(3 Suppl):S27–30
Belsante MJ, Selph JP, Peterson AC (2015) The contemporary management of urethral strictures in men resulting from lichen sclerosus. Transl Androl Urol 4(1):22–28
Levy A, Browne B, Fredrick A, Stensland K, Bennett J, Sullivan T et al (2019) Insights into the pathophysiology of urethral stricture disease due to lichen sclerosus: comparison of pathological markers in lichen sclerosus induced strictures vs nonlichen sclerosus induced strictures. J Urol 201(6):1158–1163
Erickson BA, Tesdahl BA, Voznesensky MA, Breyer BN, Voelzke BB, Alsikafi NF et al (2018) Urethral lichen sclerosus under the microscope: a survey of academic pathologists. Can J Urol 25(3):9328–9333
Gupta V, Gupta S (2017) Genital lichen sclerosus developing around ‘ectopic’ urethral orifices supports the role of occlusion and urine in its pathogenesis. Int J STD AIDS 28(9):940–942
Bunker CB, Shim TN (2015) Male genital lichen sclerosus. Indian J Dermatol 60(2):111–117
Levy AC, Browne BM, Fredrick A, Stensland K, Bennett JA, Sullivan T et al (2019) Insights into the pathophysiology of urethral stricture disease due to lichen sclerosus: comparison of pathological markers in lichen sclerosus induced strictures vs nonlichen sclerosus insduced strictures. J Urol 201(6):1158–1163
Hofer MD, Meeks JJ, Mehdiratta N, Granieri MA, Cashy J, Gonzalez CM (2014) Lichen sclerosus in men is associated with elevated body mass index, diabetes mellitus, coronary artery disease and smoking. World J Urol 32(1):105–108
Erickson BA, Elliott SP, Myers JB, Voelzke BB, Smith TG 3rd, McClung CD et al (2016) Understanding the relationship between chronic systemic disease and lichen sclerosus urethral strictures. J Urol 195(2):363–368
Grimes MD, Tesdahl BA, Schubbe M, Dahmoush L, Pearlman AM, Kreder KJ et al (2019) Histopathology of anterior urethral strictures: towards a better understanding of stricture pathophysiology. J Urol. https://doi.org/10.1097/JU.0000000000000340
Liu JS, Walker K, Stein D, Prabhu S, Hofer MD, Han J et al (2014) Lichen sclerosus and isolated bulbar urethral stricture disease. J Urol 192(3):775–779
Liaw A, Rickborn L, McClung C (2017) Incidence of urethral stricture in patients with adult acquired buried penis. Adv Urol 2017:7056173
Fuller TW, Pekala K, Theisen KM, Tapper A, Burks F, Rusilko PJ (2018) Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease. World J Urol 37(7):1409–1413. https://doi.org/10.1007/s00345-018-2514-1
Kirk PS, Yi Y, Hadj-Moussa M, Malaeb BS (2016) Diversity of patient profile, urethral stricture, and other disease manifestations in a cohort of adult men with lichen sclerosus. Investig Clin Urol 57(3):202–207
Granieri MA, Peterson AC, Madden-Fuentes RJ (2017) Effect of lichen sclerosis on success of urethroplasty. Urol Clin N Am 44(1):77–86
Lu J, Huang XD (2014) Current diagnosis and treatment of male genital lichen sclerosus. Zhonghua Nan Ke Xue 20(7):579–585
Potts BA, Belsante MJ, Peterson AC (2016) Intraurethral steroids are a safe and effective treatment for stricture disease in patients with biopsy proven lichen sclerosus. J Urol 195(6):1790–1796
Kantere D, Alvergren G, Gillstedt M, Pujol-Calderon F, Tunback P (2017) Clinical features, complications and autoimmunity in male lichen sclerosus. Acta Derm Venereol 97(3):365–369
Potts BA, Belsante MJ, Peterson AC (2016) Intraurethral steroids are a safe an effective treatment for stricture disease in patients with biopsy proven lichen sclerosus. J Urol 195(6):1790–1796
Daneshvar M, Hughes M, Nikolavsky D (2018) Surgical management of fossa navicularis and distal urethral strictures. Curr Urol Rep 19(6):43
Mangera A, Osman N, Chapple C (2016) Evaluation and management of anterior urethral stricture disease. F1000Res. https://doi.org/10.12688/f1000research.7121.1
Osterberg EC, Gaither TW, Awad MA, Alwaal A, Erickson BA, McAninch JW et al (2016) Current practice patterns among members of the american urological association for male genitourinary lichen sclerosus. Urology 92:127–131
Dielubanza EJ, Han JS, Gonzalez CM (2014) Distal urethroplasty for fossa navicularis and meatal strictures. Transl Androl Urol 3(2):163–169
Simsek A, Onol SY, Kurt O (2014) Treatment of urethral strictures in balanitis xerotica obliterans (BXO) using circular buccal mucosal meatoplasy: experience of 15 cases. Arch Ital Urol Androl 86(1):23–25
Nikolavsky D, Abouelleil M, Daneshvar M (2016) Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results. Int Urol Nephrol 48(11):1823–1829
Singh JP, Priyadarshi V, Goel HK, Vijay MK, Pal DK, Chakraborty S et al (2015) Penile lichen sclerosus: an urologist's nightmare!—a single center experience. Urol Ann 7(3):303–308
Zeller S, Vetterlein MW, Fisch M, Kluth LA (2018) Meatal and glandular urethral strictures. Urologe A 57(1):11–16
Chen L, Hou R, Feng C, Zhang X, Li D, Chen J et al (2017) Establishment of the ULTRA measurement rating system for anterior urethral stricture. Int Urol Nephrol 49(7):1201–1207
Kinnaird AS, Levine MA, Ambati D, Zorn JD, Rourke KF (2014) Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties. Can Urol Assoc J 8(5–6):E296–300
Liu JS, Dong C, Gonzalez CM (2016) Risk factors and timing of early stricture recurrence after urethroplasty. Urology 95:202–207
Kulkarni S, Kulkarni J, Surana S, Joshi PM (2017) Management of panurethral stricture. Urol Clin N Am 44(1):67–75
Xu YM, Feng C, Sa YL, Fu Q, Zhang J, Xie H (2014) Outcome of 1-stage urethroplasty using oral mucosal grafts for the treatment of urethral strictures associated with genital lichen sclerosus. Urology 83(1):232–236
Mellon MJ, Bihrle R (2014) Ventral onlay buccal mucosa urethroplasty: a 10-year experience. Int J Urol 21(2):190–193
Chodisetti S, Boddepalli Y, Kota M (2018) Repair of panurethral stricture: proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty. Arab J Urol 16(2):211–216
Warner JN, Tracey JM, Zhumkhawala AA, Chan KG, Lau CS (2016) Penile inversion through a penoscrotal incision for the treatment of penile urethral strictures. Investig Clin Urol 57(2):135–140
Mori RL, Angermeier KW (2015) Staged urethroplasty in the management of complex anterior urethral stricture disease. Transl Androl Urol 4(1):29–34
Horiguchi A (2017) Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: current topics and reviews. Int J Urol 24(7):493–503
Figler BD, Gomella A, Hubbard L (2018) Staged urethroplasty for penile urethral strictures from lichen sclerosus and failed hypospadias repair. Urology 112:222–224
Selim M, Salem S, Elsherif E, Badawy A, Elshazely M, Gawish M (2019) Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture. BMC Urol 19(1):38
Patel CK, Buckley JC, Zinman LN, Vanni AJ (2016) Outcomes for management of lichen sclerosus urethral strictures by 3 different techniques. Urology 91:215–221
Fuchs JS, Shakir N, McKibben MJ, Scott JM, Viers B, Pagliara T et al (2018) Changing trends in reconstruction of complex anterior urethral strictures: from skin flap to perineal urethrostomy. Urology 122:169–173
Lopez JC, Gomez EG, Carrillo AA, Castineira RC, Tapia MJ (2015) Perineostomy: the last oportunity. Int Braz J Urol 41(1):91–98 (discussion 9–100)
DeLong J, McCammon K, Capiel L, Rovegno A, Tonkin JB, Jordan G et al (2017) Augmented perineal urethrostomy using a dorsal buccal mucosal graft, bi-institutional study. World J Urol 35(8):1285–1290
Starke NR, Simhan J, Clinton TN, Tausch TJ, Scott JF, Klein AK et al (2015) '7-flap' perineal urethrostomy: an effective option for obese men with devastated urethras. Can J Urol 22(4):7902–7906
Taneja Y, Ram P, Dhaked SK, Sen TK (2017) Squamous cell carcinoma penis in a case of urethral stricture due to lichen sclerosus balanitis xerotica obliterans: a case report and review of literature. J Clin Diagn Res. 11(7):PD17–PD18
Levy AC, Moynihan M, Bennett JA, Sullivan T, Stensland K, Browne BM et al (2019) Protein expression profiles among lichen sclerosus urethral strictures: can urethroplasty success be predicted? J Urol. https://doi.org/10.1097/JU.0000000000000610
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Chung, A.S.J., Suarez, O.A. Current treatment of lichen sclerosus and stricture. World J Urol 38, 3061–3067 (2020). https://doi.org/10.1007/s00345-019-03030-z
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DOI: https://doi.org/10.1007/s00345-019-03030-z