The contemporary management of urethral strictures in men resulting from lichen sclerosus

Abstract

Lichen sclerosus (LS) is a chronic, inflammatory disease primarily involving the genital skin and urethra in males. Historically, the treatment of this common condition was a challenge due to its uncertain etiology, variable response to therapy, and predilection to recur. The etiology of LS is still debated and has been linked to autoimmune disease, infection, trauma, and genetics. Today, topical steroids are a mainstay of therapy for patients, even in the presence of advanced disease, and can induce regression of the disease. In advanced cases, surgery may be required and range from circumcision, meatoplasty, or, in the case of advanced stricture disease, urethroplasty or perineal urethrostomy. When urethroplasty is required, the use of genital skin as a graft or flap is to be avoided due to the predilection for recurrence. Surgical management should be approached only after failure of more conservative measures due to the high risk of recurrence of LS in the repaired site despite the use of buccal grafting. LS may be associated with the development of squamous cell carcinoma and for this reason, patients should undergo biopsy when LS is suspected and long-term surveillance is recommended.

Keywords: Lichen sclerosus (LS); urethral strictures; urethroplasty.

Figure 1

Retrograde urethrogram of LS stricture with obvious demarcation of proximal extent of disease. LS, lichen sclerosus.

Figure 2

LS algorithm. LS, lichen sclerosus.

Figure 3

Extended meatoplasty.

Figure 4

Recurrence of lichen sclerosus in buccal graft.

Figure 5

Blandy perineal urethrostomy. (A) Posterior based flap is marked; (B) dissection to bulbospongiosus muscle; (C) bulbar urethrotomy; (D) matured perineal urethrostomy.