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.
| Original language | English |
|---|---|
| Pages (from-to) | 945-956 |
| Number of pages | 12 |
| Journal | European Urology |
| Volume | 55 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2009 |
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Keywords
- Balanitis xerotica obliterans
- Lichen sclerosus
- Urethral stricture
- Urethroplasty
ASJC Scopus subject areas
- Urology
Cite this
Lichen Sclerosus of the Male Genitalia and Urethra : Surgical Options and Results in a Multicenter International Experience with 215 Patients. / Kulkarni, Sanjay; Barbagli, Guido; Kirpekar, Deepak; Mirri, Francesco; Lazzeri, Massimo.
In: European Urology, Vol. 55, No. 4, 04.2009, p. 945-956.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Lichen Sclerosus of the Male Genitalia and Urethra
T2 - Surgical Options and Results in a Multicenter International Experience with 215 Patients
AU - Kulkarni, Sanjay
AU - Barbagli, Guido
AU - Kirpekar, Deepak
AU - Mirri, Francesco
AU - Lazzeri, Massimo
PY - 2009/4
Y1 - 2009/4
N2 - 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.
AB - 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.
KW - Balanitis xerotica obliterans
KW - Lichen sclerosus
KW - Urethral stricture
KW - Urethroplasty
UR - http://www.scopus.com/inward/record.url?scp=60249092593&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=60249092593&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2008.07.046
DO - 10.1016/j.eururo.2008.07.046
M3 - Article
VL - 55
SP - 945
EP - 956
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 4
ER -