Balanopreputial sac and urine microbiota in patients with male genital lichen sclerosus

Abstract

Background Male genital lichen sclerosus (MGLSc) is a chronic inflammatory scarring dermatosis associated with penile carcinoma. The prepuce is pivotal in its etiology. Other proposed etiological factors are the subject of dispute and include occluded urinary exposure, autoimmunity, immunodysregulation, and infectious agents. Objective To determine whether the bacterial microbiota of the balanopreputial sac and urine are associated with MGLSc. Subjects and methods Twenty uncircumcised patients with MGLSc and 20 healthy uncircumcised males were enrolled in a prospective case–control study. Balanopreputial swabs and urine specimens were subjected to 16S rRNA gene amplicon sequencing. Results Microbiota analysis indicated differences between the groups. In the balanopreputial sac, the median relative abundance of Finegoldia spp. was lower (9% [range 0–60%]) in MGLSc patients than in controls (28% [range 0–62%]). Conversely, the median relative abundance of Fusobacterium spp. was higher in MGLSc patients (4% [range 0–41%]) than in controls (0% [range 0–28%]). In the urine, the median relative abundance of Finegoldia spp. was comparable between groups, whereas that of Fusobacterium spp. was higher in MGLSc patients (0% [range 0–18%] vs. 0% [range 0–5%]). There was a strong association between the microbiota composition of the balanopreputial sac and urine in MGLSc. Conclusion Dysbiosis could be involved in the etiopathogenesis of MGLSc. Further studies are required to confirm the association suggested herein and to determine its nature.

Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients

“…Most of the patients were uncircumcised at the time of the diagnosis, with the only circumcised cases being three of the four patients with PD who were referred for skin changes post circumcision (that had been performed at the same time as the reconstructive surgery). None of the 21 patients had any other predisposing factors such as autoimmunity, immunodysregulation or infectious agents 1,6 …”

“…It has become apparent (to CBB) over many years of interviewing men with MGLSc that such symptomatology is frequently present 8 . Although no specific pathogenic component of urine has been identified, urinary dysbiosis has been shown in patients with MGLSc 5,6 . Surgical management of complicated MGLSc must be designed so as not further to compromise naviculomeatal competence.…”

“…8 Although no specific pathogenic component of urine has been identified, urinary dysbiosis has been shown in patients with MGLSc. 5,6 Surgical management of complicated MGLSc must be designed so as not further to compromise naviculomeatal competence.…”

“…A culpable constituent of urine has not yet been discovered, 5 but a recent study has shown that dysbiosis of the balanopreputial sac and urine is associated with MGLSc. 6 MGLSc never occurs in men who were circumcised at birth, and is associated with trauma, instrumentation and anatomical abnormalities (e.g. frank hypospadias) that are responsible for microincontinence.…”

Lichen sclerosus following genital piercing

“…12 Furthermore, in MGLSc patients, a strong association was demonstrated between the microbiota composition of the balanopreputial sac and urine. 12 Differences in urinary microbiota composition between MGLSc patients and healthy controls have also in a separate study. 13…”