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. 2022 Jun;11(6):780-785.
doi: 10.21037/tau-22-29.

Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicentre retrospective cohort study

Michael Kwok  1   2 , Nathan Shugg  1 , Amila Siriwardana  1 , Ross Calopedos  3 , Katherine Richards  4 , Sanjeev Bandi  5 , John Hempenstall  1   2   6   7 , Prem Rashid  3   4   8   9   10 , Devang Desai  1   2   6   7
Affiliations

Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicentre retrospective cohort study

Michael Kwok et al. Transl Androl Urol. 2022 Jun.

Abstract

Background: Lichen sclerosus (LS) in men commonly involves the external genitalia, with up to 20% of these patients developing urethral stricture disease, and a small group developing malignant transformation to penile squamous cell carcinoma (SCC). The objective of this study was to determine the prevalence of LS and its sequelae in males presenting for circumcision.

Methods: A multicentre retrospective cohort study was conducted at 8 hospitals within 3 Australian regional centres. We identified males who underwent circumcision between January 2004 and November 2018 and obtained histological and clinical data. Histopathological confirmation of LS was the primary outcome. Development of urethral stricture disease and penile cancer were secondary outcomes.

Results: Six hundred and eleven patients underwent circumcision, of which 313 (51.2%) had a specimen sent for histology. Of these, 199 (63.6%) had confirmed LS where the median age at diagnosis was 65 years [interquartile range (IQR), 40-77]. Even if the remainder of unsent specimens were free of LS, the prevalence would still be 32.6%. Amongst the patients with LS, 44 (22.1%) developed urethral strictures, 1 penile SCC (0.5%), and 1 penile intraepithelial neoplasia (0.5%).

Conclusions: The prevalence of LS in patients undergoing circumcision where the foreskin was sent for histopathological review was 63.6%. In those with LS, the prevalence of urethral stricture disease was 22.1%.

Keywords: Lichen sclerosus (LS); balanitis xerotica obliterans; circumcision; prevalence; urethra.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-29/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Penile lichen sclerosus recurrence involving the glans penis and urethral meatus.
Figure 2
Figure 2
Pan-urethral stricture with near obliterative bulbar region in a patient with lichen sclerosus.
See this image and copyright information in PMC

Comment in

References

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