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Actas Urol Esp. 2017 Mar;41(2):123-131. doi: 10.1016/j.acuro.2016.09.002. Epub 2016 Nov 3.

Treatment of long anterior urethral stricture associated to lichen sclerosus.

[Article in English, Spanish]

Author information

1
Departamento Clínico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, España; Servicio de Urología, Hospital Universitario de Getafe, Madrid, España. Electronic address: jangulo@futurnet.es.
2
Departamento Clínico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
3
Departmento de Urología, State University of New York Upstate Medical University, Syracuse, NY, EE.UU.
4
Departamento de Urología, Universidad de Lisboa, Hospital de Santa María, Lisboa, Portugal.

Abstract

INTRODUCTION:

Panurethral stricture associated with lichen sclerosus is a therapeutic challenge. We present the analysis of our results using two urethroplasty techniques based on oral mucosa graft.

MATERIAL AND METHOD:

Retrospective study in patients with long anterior urethral stricture (>8cm) associated with lichen sclerosus. Patients received urethroplasty with oral mucosa graft technique according Kulkarni (n=25) or two-step Johanson-Bracka urethroplasty (n=15). Demographics, operative time, complications (Clavien-Dindo), hospital stay, days with catheter, EAV postoperative pain, failure rate, need for retreatment and functional data including IPSS, QoL, Qmax, post void residual (PVR) are evaluated.

RESULTS:

In all cases there was involvement of glandular and penile urethra, and in 75% of bulbar urethra. A single graft was used in 22.5%, two in 72.5% and three in 5%. Patients treated at a single step were younger (P=.007). Although the length of the stenosis was equivalent in both techniques (P=.96), relapse and complication rates were higher in two-step surgery (P=.05 and P=.03; respectively) and so was operative time (P<.0001) and overall stay (P=.0002). There were no differences in preoperative IPSS, QoL, Qmax or PVR, neither in postoperative values of IPSS or Qmax; but there was a difference in QoL (P=.006) and PVR (P=.03) favouring single-step urethroplasty. VAS pain on postoperative day 1 was also lower in Kulkarni urethroplasty than in the first step of Johanson-Bracka technique (P<.0001).

CONCLUSIONS:

In patients with lichen sclerosus and long anterior urethral stricture Kulkarni urethroplasty provides more efficient and better patient reported outcomes than Johanson-Bracka urethroplasty. It also prevents cosmetic, sexual and voiding temporary deterioration inherent to 2-step surgery.

KEYWORDS:

Buccal mucosa; Estenosis de uretra; Lichen sclerosus; Liquen escleroso; Mucosa bucal; Urethral stricture; Urethroplasty; Uretroplastia

PMID:
27816211
DOI:
10.1016/j.acuro.2016.09.002
[Indexed for MEDLINE]

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