Treatment of long anterior urethral stricture associated to lichen sclerosus

Abstract

IntroductionPanurethral stricture associated with lichen sclerosus is a therapeutic challenge. We present the analysis of our results using two urethroplasty techniques based on oral mucosa graft. Material and methodRetrospective study in patients with long anterior urethral stricture (>8cm) associated with lichen sclerosus. Patients received urethroplasty with oral mucosa graft technique according Kulkarni (n=25) or two-step Johanson–Bracka urethroplasty (n=15). Demographics, operative time, complications (Clavien–Dindo), hospital stay, days with catheter, EAV postoperative pain, failure rate, need for retreatment and functional data including IPSS, QoL, Qmax, post void residual (PVR) are evaluated. ResultsIn all cases there was involvement of glandular and penile urethra, and in 75% of bulbar urethra. A single graft was used in 22.5%, two in 72.5% and three in 5%. Patients treated at a single step were younger (p=0.007). Although the length of the stenosis was equivalent in both techniques (p=0.96), relapse and complication rates were higher in two-step surgery (p=0.05 and p=0.03; respectively) and so was operative time (p<0.0001) and overall stay (p=0.0002). There were no differences in preoperative IPSS, QoL, Qmax or PVR, neither in postoperative values of IPSS or Qmax; but there was a difference in QoL (p=0.006) and PVR (p=0.03) favoring single-step urethroplasty. VAS pain on postoperative day 1 was also lower in Kulkarni urethroplasty than in the first step of Johanson–Bracka technique (p<0.0001). ConclusionsIn patients with lichen sclerosus and long anterior urethral stricture Kulkarni urethroplasty provides more efficient and better patient reported outcomes than Johanson–Bracka urethroplasty. It also prevents cosmetic, sexual and voiding temporary deterioration inherent to 2-step surgery.