Editorial Comment.

Abstract

You have accessJournal of UrologyReview Article1 Oct 2021Editorial CommentThis article comments on the following:One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysisis a letter which has replyReply by Authors Benjamin Dropkin Benjamin DropkinBenjamin Dropkin Department of Urology,University of Kentucky,Lexington, Kentucky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001870.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Minimally invasive treatment options for LS strictures include topical and intraurethral steroids and extended meatotomy. Urethroplasty is required if these treatments fail. Substitution urethroplasty using genital skin flaps performs poorly in the setting of LS and has been strongly discouraged (reference 33 in article). Two-stage repair utilizing BMG demonstrated reasonable long-term success rates and became the standard of care. The requisite second procedure, substantial revision rate, and potential for cosmetic and sexual ramifications are inconveniences that could potentially be avoided with a single-stage BMG technique, which has proven to be highly successful for non-LS strictures. Whether similar results can be achieved in the LS population remains a topic of debate among reconstructive urologists. The meta-analysis by Kurtzman et al offers the strongest available support for the use of single-stage BMG urethroplasty in the treatment of LS strictures. The authors analyzed 21 retrospective case series that included 625 LS patients treated with single-stage BMG urethroplasty and found a pooled stricture recurrence rate of 10%, which rose to 18% when the analysis was limited to studies with at least 24 months of followup. A subanalysis of the studies that reported outcomes from groups of men with LS and non-LS strictures found similar short-term recurrence rates and marginally poorer outcomes in LS cases with >24 months of followup. Of note, LS-strictures involving the penile urethra were significantly less likely to recur when approached via a perineal incision with penile invagination. Several limitations are notable. This study did not include an assessment of series reporting outcomes for 2-stage urethroplasty for LS strictures. Additionally, the authors appropriately advise caution in applying the results of this meta-analysis to patients with severe stricture disease, who lack a viable urethral plate and/or demonstrate a urethral lumen less than 5Fr. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyMay 25, 2021, 12:00:00 AMOne-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-AnalysisJournal of UrologyJul 23, 2021, 12:00:00 AMReply by Authors Volume 206Issue 4October 2021Page: 851-852 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Dropkin Department of Urology,University of Kentucky,Lexington, Kentucky More articles by this author Expand All Advertisement Advertisement Loading ...