title: Obstructive complications of lichen sclerosus.
abstract: OBJECTIVE
  Young males with lichen sclerosus (LS) commonly present with phimosis; complete urinary obstruction has also been described in this population, but is much rarer. We present the case report of a boy with acute renal failure secondary to urethral obstruction caused by LS, with a review of the literature regarding the occurrence of complete urinary obstruction and renal failure associated with this disease process.
  
  
  METHODS
  A comprehensive review of the literature was conducted using MEDLINE and EMBASE to characterize the association of lichen sclerosus with significant obstructive complications of the urinary tract.
  
  
  RESULTS
  The true incidence of LS is unknown. Reported rates have ranged from 10% to 95% of boys presenting with phimosis. Our review identified 14 cases of complicated urinary obstruction (seven in children) and two cases of renal failure secondary to lichen sclerosus (both in boys).
  
  
  CONCLUSIONS
  Distinctive features make this inflammatory process identifiable to the astute physician, such that new onset of phimosis in a school-age boy should raise clinical suspicion of the diagnosis. Successful outcomes, with medical and/or surgical therapy, are commonplace in this cohort. If undiagnosed, however, progression of LS can lead to significant morbidity in the form of renal failure.
authors.affiliation: Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. matthew.christman@med.navy.mil
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Christman
authors.forename: Jamesina T
authors.initials: JT
authors.lastname: Chen
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Holmes
mesh_terms: D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications* / Q000473:pathology; D008297:Male; D010688:Phimosis / Q000209:etiology* / Q000473:pathology; D014463:Ultrasonography; D014524:Urethral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology*