Urinary Voiding Symptomatology (Micro-incontinence) in Male Genital Lichen Sclerosus

Abstract

Male genital lichen sclerosus (MGLSc) is responsible for male dyspareunia, urological morbidity and squamous carcinoma of the penis. The aetiology is essentially unknown but an autoimmune mechanism is most favoured. The first author of this paper (CBB) has argued that chronic, occluded, exposure of susceptible epithelium to urine is perniciously central to the pathogenesis (1-3). MGLSc never occurs in men who were circumcised at birth; it is associated with trauma, instrumentation, genital jewelry (piercing), and gross anatomical abnormalities (e.g. fi-ank hypospadias); it recurs in grafts, and it rarely causes perianal disease: in striking contrast with women, the male perineum is rarely chronically exposed to urinary irritation (3). Sub-preputial wetness has been associated with foreskin length and balanitis (4, 5), however GLSc has not been linked to napkin or diaper dermatitis in children although there has been a report associating it with incontinence in the elderly (6).Symptomatology associated with the leaking or dribbling of small amotmts of urine (micro-incontinence) in men may not be readily volunteered or elicited. However, it has become apparent to CBB over many years of interviewing men with GLSc that such symptomatology is frequently present. METHODSTo attempt to quantify the presence of this symptomatology in MGLSc 3 approaches to the clinical records of cases were employed.Firstly, we scrutinised the Male Genital Dermatoses Clinic (MGDC) at one of our institutions. The work load of this clinic has been described (7) as has the spécifie experience of MGLSc (3). For the last four years, each new case presenting to the weekly MGDC has been assessed by the attending physician using a routine, standard, structured form to record symptoms and signs. The patient is asked specifically about his urinary voiding patterns and habits; explicit questions are asked about post-mieturition micro-incontinence (i.e. leaking or dribbling of small quantities of urine from the urinary meatus). Over a 12 month period, all those patients, uncircumeised at presentation, diagnosed with imequivocal MGLSc (diagnosed either by punch biopsy or post-circumcision preputial specimen histologieal analysis) were identified at follow-up. A similar number of patients with an unequivocal alternative diagnosis was identified. The initial clerking forms of these MGLSc and non-MGLSc cases were then inspected to determine their presenting symptomatology.The second approach was to review the initial clerking forms of all new cases of male genital skin disease seen in 4 consecutive MGDCs and correlate the responses to the questions about voiding with the working clinical diagnosis in each case.Finally, we retrospectively reviewed the records and/or clinic letters of all the patients diagnosed clinically with MGLSc in the general dermatology clinics done by one of us in another institution over a one-year period. RESULTSIn the first study (from Spring 2010 to Spring 2011) 17 patients (mean age±SD 45.9 ±14.4 years) were identified with hist...

Differential gene hypermethylation in genital lichen sclerosus and cancer: a comparative study

“…These lesions are characterized by the presence of atrophic white plaques, and show histopathological features such as basal cell degeneration, upper dermal oedema, homogenization of collagen, and chronic inflammatory infiltration. Although the exact aetiology of this disease is uncertain, genetic predisposition, Borrelia burgdorferi infection, chronic exposure of susceptible epithelium to urine and autoimmune factors have been implicated in its pathogenesis . The concept that some, if not all, cases of LS might be caused by an infectious agent is longstanding.…”

Benign male genital dermatoses

“…In a study of 56 men with genital lichen sclerosus, 95% confessed to urinary dribbling or microincontinence. 18 The most prominent symptom is dyspareunia. 2 3 However, men might also be asymptomatic or might describe itching, burning, bleeding, splitting, rash, blister, and discomfort with urination, such as narrowing of the urinary stream or concern about the changing anatomy of the genitalia.…”

“…Urethral disease can be responsible for major urological morbidity. [18][19][20] Perianal involvement in men is rare, 3 as is concomitant extragenital lichen sclerosus (<0.1%). 21 22 Management aims to restore normal sexual function and reduce the risk of urethral disease and penis cancer.…”

Balanitis xerotica obliterans: a review of diagnosis and management

“…Post‐micturition dribbling or microincontinence has been proposed as a theoretical etiologic factor in the pathogenesis of BXO. In a study by Bunker et al ., it was demonstrated that 91% of men with diagnosed BXO reported micro‐incontinence, compared with 14% in the control group . Furthermore, in uncircumcised men, urine is more likely to pool between the prepuce and glans penis, whereupon occlusion precipitates the Koebner phenomenon and subsequent inflammation .…”