MP13-01 THE MALONE MEATOPLASTY FOR PURE MEATAL STENOSIS ASSOCIATED WITH LICHEN SCLEROSUS: RESULTS OF AN INTERNATIONAL, MULTICENTRIC STUDY

Abstract

INTRODUCTION AND OBJECTIVES: The treatment of pure meatal stenosis associated with lichen sclerosus (LS) is traditionally treated either by meatal dilatation or ventral meatotomy. These operations have a high recurrence rate and/or create a hypospadiac meatus. We present a well established operation in the use of a dorsal approach first described by the senior author in 2004. METHODS: 116 consecutive patients with stenosis of the external urinary meatus underwent a Malone meatoplasty in between 1989-2011. Mean age was 40.5 years (range 4-87 years). Range of follow up was between 6 weeks and 21 years (mean 4.2 years). Patients were followed up by questionnaire. The questionnaire ascertained if the patients were happy with the post-operative cosmetic appearance, if he sprayed when he passed urine and if so to what extent. RESULTS: 90 (78%) patients responded to a questionnaire. There were recurrences in 6 patients, 5 of whom required re-operation (4.3%). 93% patients were either happy or very happy with the cosmetic result. 87% patients never sprayed or sprayed only occasionally. Of those who sprayed only 2 patients described it as severe, one of whom had declined circumcision and had progressive LS of his foreskin. CONCLUSIONS: These results confirm that the Malone meatoplasty reliably relieves pure meatal stenosis in the long term. It is reproducible and can be performed under local anaesthetia. It can achieve excellent aesthetic results, with a low incidence of a spraying stream. Given these findings, it is not justified to perform more complex urethroplasties for strictures that do not involve the navicular fossa. Equally it seems better to perform this meatoplasty as the primary procedure rather than as salvage after failed meatal dilatation or ventral meatoplasty.