title: Lichen sclerosus and isolated bulbar urethral stricture disease.
abstract: OBJECTIVE
  Lichen sclerosus is a chronic inflammatory genital skin condition that can cause destructive urethral scarring. To our knowledge no prior study has described lichen sclerosus in isolated bulbar urethral stricture segments without progressive disease originating from the penile urethra. We report the incidence of lichen sclerosus in isolated bulbar urethral stricture segments.
  
  
  METHODS
  We retrospectively reviewed the records of 70 patients after urethroplasty for isolated bulbar stricture disease was performed from 2007 to 2013. Stricture specimens were re-reviewed by a single uropathologist. Cases were evaluated using common histological features of lichen sclerosus, including hyperkeratosis or epithelial atrophy, basal cell vacuolar degeneration, lichenoid lymphocytic infiltrate and superepithelial sclerosis.
  
  
  RESULTS
  Average patient age was 46.5 years (range 19 to 77) and average stricture length was 3.5 cm (range 1 to 7). Of the patients 51 (73.0%) underwent excision and primary anastomosis, and 19 (27.1%) underwent buccal mucosal onlay. In 6 patients (8.6%) stricture recurred during a median followup of 22 months (IQR 14, 44). Three of those patients had lichen sclerosus. Initial pathology assessment revealed lichen sclerosus in 5 patients (7.1%, 95% CI 1.0-13.3). On re-review of specimens using pathology criteria specific to lichen sclerosus 31 patients (44.3%, 95% CI 32.4-56.2) showed pathology findings highly suggestive of (13) or diagnostic for (18) lichen sclerosus (p = 0.0001). On pathological re-review lichen sclerosus was associated with recurrent stricture.
  
  
  CONCLUSIONS
  On re-review of surgical specimens we noted a significant incidence of lichen sclerosus in isolated bulbar strictures in men undergoing urethroplasty. The incidence of lichen sclerosus may be higher than reported in isolated bulbar urethral segments without evidence of distal to proximal progressive urethral disease.
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: joceline-liu@northwestern.edu.
authors.forename: Joceline S
authors.initials: JS
authors.lastname: Liu
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kelly
authors.initials: K
authors.lastname: Walker
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Daniel
authors.initials: D
authors.lastname: Stein
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Hofer
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Justin
authors.initials: J
authors.lastname: Han
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ximing J
authors.initials: XJ
authors.lastname: Yang
authors.affiliation: Departments of Urology and Pathology (SP, XJY), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D015994:Incidence; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014525:Urethral Stricture / Q000150:complications*; D055815:Young Adult
keywords: anatomy; constriction; incidental findings; lichen sclerosus et atrophicus; pathologic; urethra