Treatment of long anterior urethral stricture associated to lichen sclerosus.
BACKGROUND
Panurethral 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.


METHODS
Retrospective 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.


RESULTS
In 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=.007). Although the length of the stenosis was equivalent in both techniques (P=.96), relapse and complication rates were higher in two-step surgery (P=.05 and P=.03; respectively) and so was operative time (P<.0001) and overall stay (P=.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=.006) and PVR (P=.03) favouring 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<.0001).


CONCLUSIONS
In 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.
Departamento Clínico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, España; Servicio de Urología, Hospital Universitario de Getafe, Madrid, España. Electronic address: jangulo@futurnet.es.
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Angulo
Departamento Clínico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
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Arance
Departamento Clínico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
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Esquinas
Departmento de Urología, State University of New York Upstate Medical University, Syracuse, NY, EE.UU.
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Nikolavsky
Departamento de Urología, Universidad de Lisboa, Hospital de Santa María, Lisboa, Portugal.
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Martins
Departamento de Urología, Universidad de Lisboa, Hospital de Santa María, Lisboa, Portugal.
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Martins
D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D012189:Retrospective Studies; D014525:Urethral Stricture / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
Buccal mucosa; Estenosis de uretra; Lichen sclerosus; Liquen escleroso; Mucosa bucal; Urethral stricture; Urethroplasty; Uretroplastia