PD46-08 THE BUCCAL BELT: A BUCCAL MUCOSAL GRAFT FOR RECURRENT PENILE ADHESIONS IN PATIENTS WITH LICHEN SCLEROSIS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD46)1 Apr 2020PD46-08 THE BUCCAL BELT: A BUCCAL MUCOSAL GRAFT FOR RECURRENT PENILE ADHESIONS IN PATIENTS WITH LICHEN SCLEROSIS Matthew Beamer*, Javier Angulo Madrid, Spain, Leandro Capiel, Damian López-Alvarado, Erick Ramirez, Paksi Satyagraha Malang, Indonesia, and Dmitriy Nikolavsky Matthew Beamer*Matthew Beamer* More articles by this author , Javier Angulo Madrid, SpainJavier Angulo Madrid, Spain More articles by this author , Leandro CapielLeandro Capiel More articles by this author , Damian López-AlvaradoDamian López-Alvarado More articles by this author , Erick RamirezErick Ramirez More articles by this author , Paksi Satyagraha Malang, IndonesiaPaksi Satyagraha Malang, Indonesia More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000933.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile adhesions associated with lichen sclerosus (LS) often recur. They may cause pain, bleeding, disfigurement and patient distress. Current treatment options are limited, ranging from topical agents, repeated circumcisions, and split-thickness skin grafting. We present a novel surgical technique for treatment of refractory penile adhesions using sub-coronal buccal mucosal graft (BMG) resurfacing. METHODS: A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. The procedure involves circumferential excision of the diseased skin segment proximal to the glans. This was replaced with a circumferential 1-cm strip of BMG, secured with proximal and distal anastomosis, in addition to intervening quilts. Patients with <1-year follow-up were excluded. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcomes measures (PROMS) including SHIM questionnaire and global response assessment (GRA) questionnaire administered to measure functional and esthetic outcomes. The GRA scale ranges from -3 (markedly worse) to +3 (markedly improved). RESULTS: Twenty-four men with mean age of 59 (39-74) underwent the procedure across six institutions between 3/2014 and 10/2019. Seventeen men with >1-year follow-up met inclusion criteria. Prior treatments included topical agents 8(47%) and circumcision 15(88%). Histologically-proven LS was seen in 13(76%) patients. At the mean follow-up of 20(13-61) months no patients developed recurrence. There was no difference in pre or postoperative SHIM score (p=0.503). Overall improvement of symptoms on GRA was reported by all patients: 59% GRA+3; 24% GRA+2; 3% GRA+1. The majority of patients saw improvement in pain with intercourse: 41% GRA+3; 12% GRA+2; 35% GRA+1; 12% GRA 0. Fourteen patients (82%) reported improved in bleeding while the remaining 3 reported no change. Fifteen patients (88%) reported an improvement in esthetic appearance, 1 patient reported no change and 1 patient mild worsening. Baseline penile sensation was preserved in 14/17 (82%). The majority would recommend the procedure to a friend/relative (16/17, 94%). CONCLUSIONS: Refractory penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction. A prospective study with long-term follow up is warranted. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e922-e922 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Beamer* More articles by this author Javier Angulo Madrid, Spain More articles by this author Leandro Capiel More articles by this author Damian López-Alvarado More articles by this author Erick Ramirez More articles by this author Paksi Satyagraha Malang, Indonesia More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...