SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra—Lichen Sclerosus

Stewart, Lawrence H.; McCammon, Kurt; Metro, Michael J.; Virasoro, Ramón

doi:10.1016/j.urology.2013.09.013

Cited by 48 publications

(43 citation statements)

References 23 publications

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“…1 Reported rates of genital LS are 70 out of 100,000, but given the sensitive location of the disease the true rate is estimated to be significantly higher. 2,3 In males the disease affects the prepuce and glans penis (also known in males as balanitis xerotica obliterans), leading to phimosis, lower urinary tract symptoms and sexual dysfunction.…”

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confidence: 99%

Understanding the Relationship between Chronic Systemic Disease and Lichen Sclerosus Urethral Strictures

et al. 2016

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Purpose Lichen sclerosus is a chronic, inflammatory skin condition of the genitalia of unknown origin that accounts for nearly 10% of urethral stricture disease. In this study we determine systemic comorbidities associated with lichen sclerosus in men. Materials and Methods We analyzed data from 1,151 men who were enrolled in a multi-institutional prospective urethroplasty outcomes database. Individuals were grouped by stricture etiology, and baseline demographics, medical histories and patient reported outcome measures were retrospectively compared across groups. Results Of the 1,151 men in the database 81 (7.0%) were noted to have lichen sclerosus related urethral stricture disease. Average patient age was 46.06 ± 16.52 years, with those with lichen sclerosus being significantly older than those without lichen sclerosus (51.26 ± 13.84 vs 45.68 ± 16.64, p = 0.0011). Men with lichen sclerosus were more likely to have hypertension, hyperlipidemia and diabetes, and to use tobacco products. Controlling for age, men with lichen sclerosus related urethral stricture disease had a higher body mass index (aOR 1.089, 95% CI 1.050–1.130), and were more likely to have hypertension (aOR 2.028, 1.21–3.41) and be active tobacco users (aOR 2.0, 1.36–3.40). Mean preoperative patient reported outcome measures scores for urinary and sexual function were similar. Controlling for stricture length and location, the adjusted odds of surgical failure were higher for lichen sclerosus related urethral stricture disease (aOR 1.9, 95% CI 0.9–4.2). Conclusions Lichen sclerosus related urethral stricture disease is associated with chronic systemic diseases. This association may implicate a systemic inflammatory and/or autoimmune pathophysiology. A 2-hit mechanism implicating local and systemic factors for lichen sclerosus related urethral stricture disease development and progression is hypothesized.

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confidence: 99%

Understanding the Relationship between Chronic Systemic Disease and Lichen Sclerosus Urethral Strictures

et al. 2016

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“…This is consistent with prior reports noting that MGU-LS most commonly affects the foreskin and glans in 57%-100% of cases. 5 We found that as the disease progressed anatomically from the foreskin, to the meatus, and then to the urethra, respondents were more likely to refer their patients to a reconstructive subspecialist.…”

Section: Discussionmentioning

confidence: 79%

“…2 Symptoms of MGU-LS include a worsening urinary stream, hesitancy, incomplete emptying, erectile dysfunction, urinary retention, and/or ejaculatory dysfunction. 1,4,5 Due to the chronic, recalcitrant nature of MGU-LS, many men will require lifelong surveillance of disease progression and repeated surgical interventions. 6 Furthermore, MGU-LS is associated with an increased risk of penile squamous cell carcinoma 7 and other comorbid conditions such as hypertension, obesity, and diabetes.…”

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confidence: 99%

Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus

Osterberg

Gaither

Awad

et al. 2016

Urology

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Objective To determine the practice patterns of urologists who treat male genitourinary lichen sclerosus (MGU-LS) via a national web-based survey distributed to American Urological Association members. Methods A 20-question survey was collected from a random sample of American Urological Association members. Respondents answered questions on their practice patterns for MGU-LS diagnosis, treatment of symptomatic urethral stricture disease, surveillance, and follow-up. Results In total, 309 urologists completed the survey. The majority of respondents reported practicing more than 20+ years (37.5%) within an academic (31.7%) or group practice (31.1%) setting. The majority of respondents saw 3-5 men with MGU-LS per year (32.7%). The most common locations of MGU-LS involvement included the glans penis (66.2%), foreskin (26.3%), and/or the urethra (5.8%). Respondent first-line treatment for urethral stricture disease was direct visual internal urethrotomy (26.6%) and second-line treatment was referral to subspecialist (38.4%). After controlling for the number of patients evaluated with MGU-LS per year, those with reconstructive training were more likely to perform a primary urethroplasty for men with symptomatic urethral stricture disease (adjusted odds ratio 13.1, 95% confidence interval 5.1-33.8, P < .001). They were also more likely to counsel men on the associated penile cancer risks (adjusted odds ratio 4.6, 95% confidence interval 1.7-12.5, P < .01). Conclusion Reconstructive urologists evaluate the most number of patients with MGU-LS and are more likely to perform primary urethroplasty for urethral stricture disease. Men with MGU-LS should be referred to a reconstructive urologist to understand the full gamut of treatment options.

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“…Simple dilatation is effective with no recurrence. Furthermore, it is able to maintain the meatal integrity as well as spiraling stream of urine without splaying, a known complication of meatoplasty [8]. A critical appraisal of this fact is important as most of these patients otherwise would have been subjected to unnecessary meatoplasty which, as per our experience, is not required.…”

Section: Discussionmentioning

confidence: 99%

Meatal Occlusive Disease in Adult Males: Are There Any Clinical Variations?

Gupta¹,

Dalela

Bansal³

et al. 2016

Urol Int

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Objective: The study aimed to document the types of meatal occlusive disease (MOD) in adult males in terms of its clinical presentation, management and prognosis. Material and Methods: Eighty-six adult males with MOD were assessed during the study period. The patients were divided into Group 1, having meatal opening that was occluded by flimsy adhesions (meatal synechia/adhesive type MOD), and Group 2 that included patients who had circumferential constriction of the meatus (meatal stenosis/constrictive type MOD). All patients underwent meatal dilatation up to 18 Fr followed by self-dilatation for 3 months with topical clobetasol for 4 weeks. Degree of discomfort during self-dilation, improvement in flow rate, International Prostate Symptom Score (IPSS score) and recurrences were recorded at pre-determined intervals. Results: Twenty-eight patients had meatal synechia (Group 1) and 48 had meatal stenosis (Group 2). Discomfort during self-dilatation in Group 1 patients was significantly less; there was improvement in IPSS and peak flow rate (mean follow-up 26.8 months) as compared to Group 2. With dilation alone, no recurrence was noted in Group 1; however, Group 2 showed 62.8% recurrence indicating poor outcome in this subset of patients. Conclusion: MOD in adult males consists of 2 separate clinical entities with different therapeutic outcomes.

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SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra—Lichen Sclerosus

Cited by 48 publications

References 23 publications

Understanding the Relationship between Chronic Systemic Disease and Lichen Sclerosus Urethral Strictures

Understanding the Relationship between Chronic Systemic Disease and Lichen Sclerosus Urethral Strictures

Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus

Meatal Occlusive Disease in Adult Males: Are There Any Clinical Variations?

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