title: Reconstructive surgery of the sulcus of glans penis for balanopreputial adhesion due to lichen sclerosus. Our experience and medicolegal implications.
abstract: OBJECTIVE
  Our exeperience with the reconstructive surgery of the adhesion of the glans with the preputial skin due to lichen sclerosus.
  
  
  METHODS
  Twentyeight patients (mean age, 44 years; range, 28-69) underwent reshaping of the balanopreputial sulcus at our institution. All patients presented with trapped penis resulting from adhesion at the sulcus of glans due to Lichen Sclerosus. The procedure entailed separating the coronal adhesion along its entire length with the use of a blunttipped forceps, then reshaping the balanopreputial sulcus. Though simple, the maneuver is delicate and requires scrupulous attention to the ventral aspect to avoid damaging the urethra. The adhesion is removed circumferentially around the glans by means of electrobistoury.
  
  
  RESULTS
  The duration of the follow-up period was 24 months. All patients stated they were satisfied with the cosmetic results and functional outcome. Recurrence of the condition occurred in 7% of the patients and was treated medically; recurrence of adhesion occurred in 2% of the patients and was treated with repeat surgery.
  
  
  CONCLUSIONS
  The indication for medical therapy in early LS is a selective criterion restricted to less severe cases; otherwise, the physician may be held responsible for treatment failure, justified claims for reimbursement, disease progression and the decidedly greater damage that may ensue. Such consequences can be averted when assessment is based on recent scientific evidence and the approach to treatment is appropriate in terms of efficacy and effectiveness. Surgical management is definitive and restores normal penile anatomy and function, including sexual and urinary function, thus enabling the patient to regain sexual confidence
  
  
  CONCLUSIONS
  Lichen sclerosus et atrophicus is a rare disease, however, its management is not devoid of medicolegal considerations. The etiopathogenesis of the disease is unknown but progression to carcinoma of the penis has been reported in untreated cases. Consequently, timely diagnosis holds medicolegal relevance for averting delayed initiation of treatment. In cases of balanopreputial adhesion with disappearance of the sulcus of glans, we proceed with lysis and reshaping of the sulcus by means of a simple technique we have developed. The technique involves separating the coronal adhesion circumferentially around the glans using a blunt-tipped forceps, then reshaping the balanopreputial sulcus. Though very simple, the procedure is also delicate as the surgeon must be careful not to damage the urethra beneath the ventral surface.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Alei
authors.forename: Piero
authors.initials: P
authors.lastname: Letizia
authors.forename: Lavinia
authors.initials: L
authors.lastname: Alei
authors.forename: Francesco
authors.initials: F
authors.lastname: Massoni
authors.forename: Serafino
authors.initials: S
authors.lastname: Ricci
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D004598:Electrosurgery / Q000331:legislation & jurisprudence / Q000379:methods; D004954:Esthetics; D005260:Female; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010409:Penile Diseases / Q000150:complications / Q000601:surgery*; D010410:Penile Erection; D010413:Penis / Q000601:surgery*; D010688:Phimosis / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000331:legislation & jurisprudence / Q000379:methods*; D020127:Recovery of Function; D012008:Recurrence; D012648:Self Care; D014554:Urination; D013519:Urogenital Surgical Procedures / Q000331:legislation & jurisprudence / Q000379:methods*