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Eur Urol. 2009 Apr;55(4):945-54. doi: 10.1016/j.eururo.2008.07.046. Epub 2008 Jul 30.

Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients.

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  • 1Center for Reconstructive Urethral Surgery, Pune, India.

Abstract

BACKGROUND:

Surgical options in male patients with genital lichen sclerosus (LS) involving the anterior urethra still represent a challenging issue.

OBJECTIVE:

To review the outcome of surgical treatment in patients with genital and urethral LS.

DESIGN, SETTING, AND PARTICIPANTS:

Multicenter, international, retrospective, observational descriptive study performed in two specialized centers. Two hundred fifteen male patients underwent surgery for histologically proven genital LS involving the foreskin and/or the anterior urethra.

INTERVENTION:

Circumcision (34 cases), meatotomy (15 cases), circumcision and meatotomy (8 cases), one-stage penile oral mucosal graft urethroplasty (8 cases), two-stage penile oral mucosal graft urethroplasty (15 cases), one-stage bulbar oral mucosal graft urethroplasty (88 cases), and definitive perineal urethrostomy (47 cases).

MEASUREMENTS:

Primary outcome was considered a failure when any postoperative instrumentation was needed, including dilation, or when recurrence was diagnosed.

RESULTS AND LIMITATIONS:

The average follow-up was 56 mo (range: 12-170 mo). Circumcision showed 100% success rate with no recurrence of the disease; meatotomy, 80% success rate; circumcision and meatotomy, 100% success rate; one-stage penile oral mucosal graft urethroplasty, 100% success rate; two-stage penile oral mucosal graft urethroplasty, 73% success rate; one-stage bulbar oral mucosal graft urethroplasty, 91% success rate; and definitive perineal urethrostomy, 72% success rate. Limitations include short follow-up for recording neoplastic degeneration and no instrument to investigate quality of life.

CONCLUSIONS:

Patients with LS disease restricted to the foreskin and/or external urinary meatus showed a high surgery success rate. In patients with penile urethral strictures or panurethral strictures, the use of one-stage oral graft urethroplasty showed greater success than the staged procedures.

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PMID:
18691809
[PubMed - indexed for MEDLINE]
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