Treatment of long anterior urethral stricture associated to lichen sclerosus

Angulo, Javier; Arance, I.; Esquinas, Cristina; Nikolavsky, Dmitriy; Martins, Natália; Martins, Francisco E.

doi:10.1016/j.acuroe.2016.12.007

Cited by 6 publications

(9 citation statements)

References 36 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Single-stage urethroplasty with BMG is a feasible treatment for panurethral stricture due to LS and has been suggested to be preferable over a two-stage urethroplasty (18). In this sense, Kulkarni et On the other hand, it prevents the cosmetic and functional deterioration inherent in two-stage surgery (45). A recent systematic review showed that stricture free-rate in patients with LS underwent urethroplasty was 88% vs. 60% for single-stage and staged urethroplasty respectively (46).…”

Section: Discussionmentioning

confidence: 99%

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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

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

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Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture.Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008][2009][2010][2011][2012][2013][2014][2015][2016][2017][2018][2019][2020][2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments.Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. months).Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs.2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis.Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

View full text Add to dashboard Cite

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“…As a general clinical practice guide, single-stage urethroplasties do not seem to have lower success rates compared to staged urethroplasties, as described in a recent narrative review, and should therefore be performed in selected cases [ 16 ]. However, the authors state that the overall quality of the studies included is low because of the absence of a comparator, and only one non-randomized retrospective controlled study is present [ 17 ]. In this study, 1St-BMGU had a slightly significantly higher success rate than 2St-BMGU, lower operative time, complications, hospital stay, postoperative pain, and higher reported quality of life.…”

Section: Discussionmentioning

confidence: 99%

The Role of Multi-Staged Urethroplasty in Lichen Sclerosus Penile Urethral Strictures

Palminteri¹,

Gobbo

Preto

et al. 2022

JCM

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Background: One-stage buccal mucosa graft urethroplasty (BMGU) is advised for non-obstructing, simple penile strictures due to lichen sclerosus (LS), while a multistage approach is preferred for most complex cases. Our study aims to evaluate long-term treatment outcomes and patient-reported outcomes (PROs) in patients undergoing multistage BMGU for LS-associated penile strictures. Methods: This is a retrospective analysis of prospectively collected data on multistage penile BMGU from 2001. All patients underwent a 2-stage (2St) or 3-stage (3St) BMGU with the final closure of the urethral plate. PROs were collected from a pre-defined questionnaire. Results: Twenty patients were successfully treated, while five experienced recurrence. If a first-stage Johanson was only performed, a 3St-BMGU was more likely, and higher treatment success was observed. A time course between the first and last stages shorter than 12 m was an independent predictor of treatment failure. Patients reported high overall satisfaction and urinary flow improvement. Sexual life was not significantly affected, while aesthetic appearance was the most affected dimension. Conclusions: Staged approaches have satisfactory treatment success rates, likely depending on the duration from the first to the last stage. PROs do not differ based on the number of stages performed, and overall satisfaction with the procedure is high.

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“…Angulo et al. reported a 40% recurrence rate in patients with long anterior urethral stricture due to LS managed with multistage repair, and a 12% recurrence rate in those treated by single‐stage repair …”

Section: Discussionmentioning

confidence: 99%

“…21,22 Angulo et al reported a 40% recurrence rate in patients with long anterior urethral stricture due to LS managed with multistage repair, and a 12% recurrence rate in those treated by single-stage repair. 23 In the literature, the success rate of single-stage BMG urethroplasty for strictures in LS patients is 65.8-91.7%. 24,25 In the present study, the success rate was 88.2% using LMG, which is similar to the published results.…”

Section: Discussionmentioning

confidence: 99%

Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: Long‐term outcomes

et al. 2020

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Objective To evaluate the long‐term outcomes of dorsal onlay urethroplasty using lingual mucosal graft for repairing urethral strictures associated with genital lichen sclerosis. Methods This study included 36 patients who had lichen sclerosis long anterior urethral strictures that were managed with dorsal onlay urethroplasty using lingual mucosal graft, and were followed up ≥5 years. Preoperatively, we measured the maximum urinary flow rate and the International Prostate Symptom Score, then every 3 months in the first year, and annually thereafter. During follow up, patients with obstructive symptoms were subjected to urethrography and/ or urethroscopy. A successful urethroplasty was defined as normal voiding and no need for further intervention. Results Of the 36 patients, two were lost during the follow up, thus 34 patients were involved in the assessment. After lingual mucosal graft urethroplasty, there were significant improvements in maximum urinary flow rate and International Prostate Symptom Score (P < 0.0001). This improvement was sustained during the 5‐year follow‐up period. The median follow‐up period was 66.5 months (interquartile range 64–70 months). The overall success rate in this study was 88.2%. Postoperative complications that required intervention were reported within the first year in four (11.8%) patients. Oral site complications were mild in the early postoperative period with no long‐term complications. Conclusions Dorsal onlay urethroplasty using lingual mucosal graft is a reliable and durable procedure for repairing lichen sclerosis urethral stricture. It provides a long‐term success rate with few failures occurring within the first year. Lingual mucosal graft harvesting is associated with minor, immediate oral complications, and no long‐term morbidity.

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Treatment of long anterior urethral stricture associated to lichen sclerosus

Cited by 6 publications

References 36 publications

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

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

The Role of Multi-Staged Urethroplasty in Lichen Sclerosus Penile Urethral Strictures

Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: Long‐term outcomes

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