title: The contemporary management of urethral strictures in men resulting from lichen sclerosus.
abstract: Lichen sclerosus (LS) is a chronic, inflammatory disease primarily involving the genital skin and urethra in males. Historically, the treatment of this common condition was a challenge due to its uncertain etiology, variable response to therapy, and predilection to recur. The etiology of LS is still debated and has been linked to autoimmune disease, infection, trauma, and genetics. Today, topical steroids are a mainstay of therapy for patients, even in the presence of advanced disease, and can induce regression of the disease. In advanced cases, surgery may be required and range from circumcision, meatoplasty, or, in the case of advanced stricture disease, urethroplasty or perineal urethrostomy. When urethroplasty is required, the use of genital skin as a graft or flap is to be avoided due to the predilection for recurrence. Surgical management should be approached only after failure of more conservative measures due to the high risk of recurrence of LS in the repaired site despite the use of buccal grafting. LS may be associated with the development of squamous cell carcinoma and for this reason, patients should undergo biopsy when LS is suspected and long-term surveillance is recommended.
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Belsante
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Selph
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
keywords: Lichen sclerosus (LS); urethral strictures; urethroplasty
references.citation: Br J Dermatol. 1999 Jan;140(1):79-83
references.pmid: 10215772
references.citation: Int J Dermatol. 1982 May;21(4):192-7
references.pmid: 7047416
references.citation: Clin Obstet Gynecol. 2005 Dec;48(4):808-17
references.pmid: 16286827
references.citation: J Urol. 2012 Sep;188(3):824-30
references.pmid: 22818345
references.citation: Br J Dermatol. 2009 Feb;160(2):459-60
references.pmid: 19077073
references.citation: J Urol. 2005 Feb;173(2):463-6
references.pmid: 15643208
references.citation: J Urol. 2010 Apr;183(4):1395-9
references.pmid: 20171665
references.citation: Br J Dermatol. 2001 Jul;145(1):85-9
references.pmid: 11453912
references.citation: Trans St Johns Hosp Dermatol Soc. 1971;57(1):9-30
references.pmid: 5570266
references.citation: Acta Derm Venereol. 1977;57(3):275-7
references.pmid: 71837
references.citation: Int J Gynaecol Obstet. 2007 Feb;96(2):117-21
references.pmid: 17239881
references.citation: Br J Dermatol. 2011 Feb;164(2):325-9
references.pmid: 20973765
references.citation: J Am Acad Dermatol. 1999 Dec;41(6):911-4
references.pmid: 10570372
references.citation: Br J Dermatol. 1988 Jan;118(1):41-6
references.pmid: 3342175
references.citation: Br J Urol. 1998 May;81(5):735-7
references.pmid: 9634051
references.citation: J Urol. 2014 Sep;192(3):775-9
references.pmid: 24657836
references.citation: Am J Obstet Gynecol. 1990 Jun;162(6):1633-4
references.pmid: 2163194
references.citation: Clin Exp Dermatol. 2006 May;31(3):343-7
references.pmid: 16681572
references.citation: Urology. 2011 Jun;77(6):1487-9
references.pmid: 21256550
references.citation: BJU Int. 2009 Oct;104(8):1150-5
references.pmid: 19388990
references.citation: Dermatologica. 1990;181(1):76-7
references.pmid: 2394311
references.citation: J Urol. 2009 Aug;182(2):548-57
references.pmid: 19524945
references.citation: J Urol. 2007 Jan;177(1):184-7; discussion 187
references.pmid: 17162036
references.citation: Minerva Urol Nefrol. 2004 Jun;56(2):189-203
references.pmid: 15195026
references.citation: J Dtsch Dermatol Ges. 2006 Oct;4(10):842-7
references.pmid: 17010173
references.citation: J Urol. 2012 Jun;187(6):2101-5
references.pmid: 22503028
references.citation: World J Urol. 2000 Dec;18(6):382-7
references.pmid: 11204255
references.citation: J Urol. 2003 Sep;170(3):923
references.pmid: 12913735
references.citation: J Urol. 2006 Apr;175(4):1359-63
references.pmid: 16515998
references.citation: Eur Urol. 2009 Apr;55(4):945-54
references.pmid: 18691809
references.citation: Pediatr Dermatol. 1998 Mar-Apr;15(2):85-90
references.pmid: 9572688
references.citation: J Am Acad Dermatol. 1999 Mar;40(3):451-7
references.pmid: 10071317
references.citation: J Urol. 2011 Jun;185(6):2171-6
references.pmid: 21497838
references.citation: Br J Dermatol. 2004 Sep;151(3):627-35
references.pmid: 15377350
references.citation: J Dermatolog Treat. 2013 Dec;24(6):431-4
references.pmid: 23472631
references.citation: BJU Int. 2000 Sep;86(4):459-65
references.pmid: 10971272
references.citation: Urology. 2004 Sep;64(3):565-8
references.pmid: 15351594
references.citation: Br J Dermatol. 2006 Nov;155(5):1021-8
references.pmid: 17034535
references.citation: J Urol. 2001 Jan;165(1):219-20
references.pmid: 11125410
references.citation: South Med J. 2003 Jan;96(1):9-11
references.pmid: 12602705
references.citation: J Urol. 2007 Dec;178(6):2268-76
references.pmid: 17936829
references.citation: J Dtsch Dermatol Ges. 2003 Mar;1(3):206-11
references.pmid: 16285496
references.citation: J Urol. 2004 Sep;172(3):949-52
references.pmid: 15311006
references.citation: Eur J Cell Biol. 2005 Mar;84(2-3):273-7
references.pmid: 15819407
references.citation: J Urol. 2011 Feb;185(2):522-5
references.pmid: 21168879
references.citation: Obstet Gynecol. 1976 Jan;47(1):122-4
references.pmid: 174037
references.citation: Urology. 2014 Mar;83(3 Suppl):S27-30
references.pmid: 24268357
references.citation: BJU Int. 2011 Mar;107(5):856-65
references.pmid: 21355988
references.citation: BJU Int. 2007 Nov;100(5):1143-5
references.pmid: 17627782
references.citation: Br J Dermatol. 1995 Feb;132(2):197-203
references.pmid: 7888355
references.citation: Lancet. 2003 Jul 12;362(9378):118-23
references.pmid: 12867112
references.citation: Lancet. 1999 May 22;353(9166):1777-83
references.pmid: 10348006
references.citation: Eur Urol. 2008 Oct;54(4):932-7
references.pmid: 18374471