Lichen sclerosus of male genitalia involving anterior urethra

Lancet 1999; 354 (number 9176): 429.
Sir—In their review of lichen sclerosus, J Powell and F Wojnarowska (May 22, p 1777)1 are concerned about the risk of scarring and malignant disease. They did not report the incidence of lichen sclerosus involving anterior urethra in adult men and did not place the right emphasis on this matter.
In our experience, from 1991 to 1998, of 106 patients who underwent urethroplasty for urethral stricture disease, 31 (29%) received a specific pathological diagnosis of lichen sclerosus, which involved external meatus in six (19%) patients, fossa nevicularis in five (16%), penile urethra in four (3%), and a panurethral disease in 16 (52%). After urethroplasty, a successful result was observed in nine (29%) patients who had lichen sclerosis, whereas the other 22 (71%) were scheduled for second-stage urethral reconstruction at different sites.
Lichen sclerosis should be thought of as the clinical manifestation of a complex disease of male genitalia that involves the cosmetic appearance of genitalia and both sexual and urinary function. The knowledge of embryological development of glandular urethra may explain the involvement of glandular tract,2 but the involvement of whole anterior urethra, as observed in some patients, remains unknown. The involvement of anterior urethra may represent a devastating disease and patients must be informed that complex and multiple procedures are needed to control the disease.3 We recommend a timing diagnosis based on histopathological examination and early treatment to avoid urethral involvement.