Managing Urethral Strictures in Men From Lichen Sclerosus
Lichen sclerosus (LS) is a chronic, inflammatory disease primarily involving the genital skin and urethra in males. Historically, the treatment of this common condition was a challenge due to its uncertain etiology, variable response to therapy, and predilection to recur. The etiology of LS is still debated and has been linked to autoimmune disease, infection, trauma, and genetics. Today, topical steroids are a mainstay of therapy for patients, even in the presence of advanced disease, and can induce regression of the disease. In advanced cases, surgery may be required and range from circumcision, meatoplasty, or, in the case of advanced stricture disease, urethroplasty or perineal urethrostomy. When urethroplasty is required, the use of genital skin as a graft or flap is to be avoided due to the predilection for recurrence. Surgical management should be approached only after failure of more conservative measures due to the high risk of recurrence of LS in the repaired site despite the use of buccal grafting. LS may be associated with the development of squamous cell carcinoma and for this reason, patients should undergo biopsy when LS is suspected and long-term surveillance is recommended.
Lichen sclerosus (LS) is an inflammatory disease that can affect both men and women and shows a predilection for the anogenital region. It is a lymphocyte-mediated process that, in men, affects the genital skin and also the urethra, causing urethral stricture. Formerly known as balanitis xerotica obliterans (BXO), LS was first described in the late 19 century and the male form specifically by Stuhmer in 1928. The term BXO had been used interchangeably with LS, however LS is currently used exclusively since the formal adoption of the term by the International Society for the Study of Vulvar Disease. LS is the most common cause of long pan-urethral stricture in males.
Abstract and Introduction
Abstract
Lichen sclerosus (LS) is a chronic, inflammatory disease primarily involving the genital skin and urethra in males. Historically, the treatment of this common condition was a challenge due to its uncertain etiology, variable response to therapy, and predilection to recur. The etiology of LS is still debated and has been linked to autoimmune disease, infection, trauma, and genetics. Today, topical steroids are a mainstay of therapy for patients, even in the presence of advanced disease, and can induce regression of the disease. In advanced cases, surgery may be required and range from circumcision, meatoplasty, or, in the case of advanced stricture disease, urethroplasty or perineal urethrostomy. When urethroplasty is required, the use of genital skin as a graft or flap is to be avoided due to the predilection for recurrence. Surgical management should be approached only after failure of more conservative measures due to the high risk of recurrence of LS in the repaired site despite the use of buccal grafting. LS may be associated with the development of squamous cell carcinoma and for this reason, patients should undergo biopsy when LS is suspected and long-term surveillance is recommended.
Introduction
Lichen sclerosus (LS) is an inflammatory disease that can affect both men and women and shows a predilection for the anogenital region. It is a lymphocyte-mediated process that, in men, affects the genital skin and also the urethra, causing urethral stricture. Formerly known as balanitis xerotica obliterans (BXO), LS was first described in the late 19 century and the male form specifically by Stuhmer in 1928. The term BXO had been used interchangeably with LS, however LS is currently used exclusively since the formal adoption of the term by the International Society for the Study of Vulvar Disease. LS is the most common cause of long pan-urethral stricture in males.
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