Lichen Sclerosus of the Male Genitalia and Urethra

Surgical Options and Results in a Multicenter International Experience with 215 Patients

Sanjay Kulkarni, Guido Barbagli, Deepak Kirpekar, Francesco Mirri, Massimo Lazzeri

Research output: Contribution to journalArticle

101 Citations (Scopus)

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 languageEnglish
Pages (from-to)945-956
Number of pages12
JournalEuropean Urology
Volume55
Issue number4
DOIs
Publication statusPublished - Apr 2009

Fingerprint

Oral Stage
Lichen Sclerosus et Atrophicus
Male Genitalia
Urethra
Transplants
Foreskin
Recurrence
Urethral Stricture
Observational Studies
Dilatation
Pathologic Constriction
Quality of Life

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 journalArticle

Kulkarni, Sanjay ; Barbagli, Guido ; Kirpekar, Deepak ; Mirri, Francesco ; Lazzeri, Massimo. / Lichen Sclerosus of the Male Genitalia and Urethra : Surgical Options and Results in a Multicenter International Experience with 215 Patients. In: European Urology. 2009 ; Vol. 55, No. 4. pp. 945-956.
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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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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.

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