Conservative Management of Lichen Sclerosus-induced Male Urethral Strictures: Can urethral reconstruction be safely avoided?
Alexander Rozanski, MD, Lawrence Zhang, BA, Steven Copacino, BA, Alex Vanni, MD.
Lahey Hospital and Medical Center, Burlington, MA.
Background: Lichen sclerosus-induced urethral stricture disease (LS-USD) creates surgical challenges for the reconstructive urologist due to the high risk of stricture recurrence and disease progression. We reviewed the outcomes of such patients at our institution to determine if conservative management can be an effective strategy.
Methods: We retrospectively identified patients with LS-USD who were managed with urethral balloon dilation or clean intermittent catheterization (CIC) +/- intraurethral steroids. Any patient who had an obliterative stricture, underwent urethral reconstruction as the primary means of USD treatment, or had less than 3 months follow-up was excluded. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, and uroflowmetry values. Secondary outcome measures were Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire (MSHQ) scores.
Results: A total of 109 men met inclusion criteria between 2005-2019 with a median follow-up of 24 months (IQR 8-49). Median age was 52.2 years, body mass index was 35.5 kg/m2, and Charlson comorbidity index was 1. Median stricture length on retrograde urethrogram was 10 cm (IQR 2-20). Stricture location was: meatus/fossa navicularis (33%), pendulous (9%), and bulbopendulous (58%). The most common urinary symptoms were slow flow (50%), sitting to void (25%), and spraying (23%). A total of 77 (71%) patients underwent subsequent urethral dilation. Median number of dilations per patient was 1 (IQR 1-3). CIC was utilized in 32% of patients, with 32% of this subgroup applying steroids intraurethrally via CIC. Uroflowmetry values and sexual health questionnaires showed no significant change between first and last visits (Table 1). Median serum creatinine at first and last visits remained unchanged at 1.0 mg/dL. Eight (7%) patients had an AUR episode requiring urgent treatment and 20 (18%) had a stricture-related UTI.
Conclusions: Although certain patients will desire or require urethral reconstruction, many patients with LS-USD, across a wide range of stricture lengths and locations, appear to be safely managed with urethral dilation or CIC +/- intraurethral steroids. Close observation is warranted due to the risk of stricture-related UTIs and AUR episodes.
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