One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis

Abstract

Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. Materials and Methods: A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Results: Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6e14). Among studies with longer followup (!24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p[0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p[0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p[0.05). Conclusions: One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair.

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

“…A recently published systematic review demonstrated no significant difference between the pooled recurrence rate in patients with LS compared to patients without LS (P=0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, P=0.05) (42).…”

“…Four patients (8.3%) have undergone endoscopic urethrotomy. Median patient's age was 37 [interquartile range (IQR) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] years in LS group and 54 (IQR 20-84) years in idiopathic group. Stricture length was 8 (IQR 5-8) cm in LS group and 3 (IQR 2.5-4) cm in idiopathic group.…”

Complications of primary and recurrent buccal urethroplasty in men.

“…Так, по данным M. Spilotros и соавт., из 24 пациентов со стриктурой пенильного отдела уретры, вызванной лихен склерозом, рецидив стриктуры возник в 10 случаях (41,7%) [31]. В то же время по данным других авторов при использовании буккальной уретропластики эффективность операции практически не уступает среднестатистическим значениям [66,67].…”