The Management of Lichen Sclerosus Urethral Strictures by 3 Different Techniques: a single-center surgical algorithm based on the evaluation of corpus spongiosum

BackgroundLichen sclerosus (LS) is a chronic, inflammatory disease of unknown cause which occurs in the male genital area and can affect the external genital and the anterior urethra. Nowdays, urethral stricture associated with LS is still a challenge to urologists and different surgical options are employed according to surgeons’ personal preferences. In this study, we report our experience of surgical treatments for genital lichen sclerosus urethral stricture and try to share our surgical algorithm. MethodsBetween March 2013 and March 2018, 55 patients with LS urethral strictures underwent three different surgical techniques including of Kulkarni technique, Bracka technique and perineal urethrostomy (PU). Approaches were chosen according to the evaluation of the degree of spongiofibrosis and patients’ wishes. ResultsThe overall success rate was 74.55%. Kulkarni technique was performed in 37 patients with a success rate of 78.38%. 12 patients who were planned for staged substitution urethroplasty, developed a 50% success rate, including 3 local graft contractures following the first stage, 2 fistulas and 1 dehiscence following the urethroplasty respectively. PU was chosen as the primary treatment in 6 patients and performed as salvage surgery on 4 patients, which resulted a 100% success rate. Comparing to the Kulkarni and Bracka techniques, PU offers the highest degree of success and could be considered as a final salvage for all patients and statistic difference was found between three techniques (P=0.0082). ConclusionThe staged urethroplasty by excising corpus spongiosum consumed more cost of time and money but could not provide similar therapeutic effects as the Kulkarni technique and PU. Therefore, the evaluation of corpus spongiosum is a necessary step in the surgical decision making which can make surgeons avoid unsuitable decisions and improve the success rate.