Lichen sclerosus – Circumcision

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Lichen sclerosus cause destructive scarring that can lead to urinary and sexual problems and a decrease of quality of life. Symptoms are pruritus and soreness, difficulty in retracting the foreskin and a poor urinary stream. Examination shows typical flat, atrophic, ivory to white colored papules that coalesce in plaques of varying sizes, commonly with a non-retractile prepuce and meatal stenosis.

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Lecture n° 1:

Reconstruction of urethral strictures due to lichen sclerosus
28th Congress of the Société Internationale d’Urologie
November 12 – 16, 2006
Cape Town – South Africa

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Lecture n° 2:
BXO – Lichen sclerosus
III° Simposio Internacional de Cirurgia Urologica Reconstrutora
April 11-12, 2008
Rio de Janeiro-Brazil

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Lecture n° 3:
Lichen sclerosus genito-urinario
Società Italiana Urologia Territoriale (SIUT)
Urologi Ospedalità Privata (Ur.O.P.)
September 22 – 28, 2008
Rome – Italy

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Lecture n° 4:
Lichen sclerosus
Overview: etiology, clinical presentation and management

Muljibhai Patel Urological Hospital “URETHROPLASTY”
July 19 – 20, 2012
Nadiad – Gujarat – India

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Article n° 1
Lichen sclerosis of male genitalia involving anterior urethra
Lancet 1999; 354(number 9176): 429.


Article n° 2
Lichen sclerosus involving anterior urethra
J. Urol 1999; 16 1: 102 (Abstract 384).

L. S. involving anterior urethra is a devastating disease, and the patient must be informed that complex and multiple producers will be necessary to control the disease.

Article n° 3
Lichen Sclerosus of the male genitalia
Contemporary Urology 2001; 13:, 47-58.

The urinary and sexual sequelae of this chronic inflammatory skin condition are often devastating. Early recognition and treatment improve chances for a satisfactory outcome.

Article n° 4
Lichen sclerosus of the male genitalia and urethral stricture diseases
Urol Int 2004; 73: 1-5.

Introduction: The true incidence of urethral involvement in patients with genital lichen sclerosus (LS) is unknown. We review the epidemiology and discuss the pathogenesis of LS and urethral stricture diseases.
Materials and Metohods: During the period 1991-2002, of 925 patients who underwent urethroplasty for anterior urethral stricture, 130 patients (14%) received the diagnosis of LS. In all patients with LS the histology was re-examined to confirm the clinical diagnosis. Retrograde and voiding urethrography was used to establish urethral involvement in the disease.
Results: In 106 patients (82%) the histology provided the classical features of LS, and 24 patients (18%) showed some histological variations. In 49 patients (37%) the LS involved the pendolous urethra (meatus-navicularis-penile), and in 53 cases (41%) a panurethral stricture was evident.
Conlusions: LS urethral involvement appears to be a much more common and extensive disease than previously reported, and requires particular care in its early diagnosis.

Article n° 5
Penile carcinoma in patients with genital lichen sclerosus: a multicenter survey
J Urol 2006; 175: 1359-1363.

Purpose: In this observational descriptive study we reviewed the histology and the clinical records of 130 patients with LS involving the male genitalia to determine the presence of premalignant or malignant lesions.
Materials and Methods: A total of 130 male patients (from 1991 to 2001) with genital LS were treated at our centers. Mean patient age at diagnosis was 42.5 years. In all patients with a clinical diagnosis of LS, the histology was reexamined to look for evidence of LS, applying strict histological criteria. All cases of histologically proven epithelial malignancy, namely SCC, VC and EQ, were reviewed to confirm the presence of neoplastic changes and ascertain the degree of SCC differentiation.
Results: Of 130 men 11 (8.4%) with genital LS showed premalignant or malignant histopathological features including 7 (64%) with SCC, 2 (18%) with VC, 1 (9%) with EQ and 1 (9%) with SCC associated with VC. In 6 of 11 patients (55%) the histological study showed the presence of epithelial dysplasia.
Conclusions: Survival of patients with penile carcinoma depends on early diagnosis and treatment, and all patients with genital LS should be observed closely to detect the development of neoplastic or preneoplastic lesions as early as possibile.

Article n° 6
Resurfacing and reconstruction of the glans penis
Eur Urol 2007; 52: 893-900.

Objectives: To describe the techniques and results of surgical reconstruction of glans penis lesions.
Methods: Seventeen patients (mean age: 53.2 yr) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was one Zoon’s balanitis, four lichen sclerosus, one carcinoma in situ, five squamous cell carcinomas, and six squamous cell carcinomas associated with lichen sclerosus. Five cases were treated by glans skinning and resurfacing; five cases by glans amputation and reconstruction of the neoglans, and seven cases by partial penile amputation and reconstruction of the neoglans. Glans resurfacing and reconstruction were performed with the use of a skin graft harvested from the thigh.
Results: The mean follow-up was 32 mo. All patients were free of local premalignant/malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neoglans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/penile amputation.
Conclusions: In selected cases of benign, premalignant or malignant penile lesions, glans resurfacing or reconstruction can ensure a normal appearing and functional penis, without jeopardizing cancer control.

Article n° 7
Lichen Sclerosus of the Male Genitalia and Urethra: Surgical Options and Results in a Multicenter International Experience with 215 Patients
Eur Urol 2009; 55: 945-956.

Background: Surgical options in male patients with genital lichen sclerosus (LS) involving the anterior urethra still represent a challenging issue.
Objective: To review the outcome of surgical treatment in patients with genital and urethral LS. Design, Setting, and Participants: Multicenter, international, retrospective, observational descriptive study performed in two specialized centers. Two hundred fifteen male patients underwent surgery for histologically proven genital LS involving the foreskin and/or the anterior urethra.
Intervention: Circumcision (34 cases), meatotomy (15 cases), circumcision and meatotomy (8 cases), one-stage penile oral mucosal graft urethroplasty (8 cases), two-stage penile oral mucosal graft urethroplasty (15 cases), one-stage bulbar oral mucosal graft urethroplasty (88 cases), and definitive perineal urethrostomy (47 cases).
Measurements: Primary outcome was considered a failure when any postoperative instrumentation was needed, including dilation, or when recurrence was diagnosed. Results and Limitations: The average follow-up was 56 mo (range: 12-170 mo). Circumcision showed 100% success rate with no recurrence of the disease; meatotomy, 80% success rate; circumcision and meatotomy, 100% success rate; one-stage penile oral mucosal graft urethroplasty, 100% success rate; two-stage penile oral mucosal graft urethroplasty, 73% success rate; one-stage bulbar oral mucosal graft urethroplasty, 91% success rate; and definitive perineal urethrostomy, 72% success rate. Limitations include short follow-up for recording neoplastic degeneration and no instrument to investigate quality of life.
Conclusions: Patients with LS disease restricted to the foreskin and/or external urinary meatus showed a high surgery success rate. In patients with penile urethral strictures or panurethral strictures, the use of one-stage oral graft urethroplasty showed greater success than the staged procedures.
1. Question: Is the surgical procedure fully covered by the National Health Care System?
Answer: Yes.


2. Question: What kind of anesthesia is used for this surgery?
Answer: General anesthesia without oro-tracheal intubation.


3. Question: How many hours does the surgery take?
Answer: About 1/2 hour.


4. Question: Are there any risks concerning erection?
Answer: No.


5. Question: How many days of hospital recovery are expected following the surgery?
Answer: One day.


6. Question: How long will I have to use a urethral catheter following surgery?
Answer: No catheter is used in this procedure.


7. Question: Are there any particular recommendations during convalescence?
Answer: During convalescence, antibiotic use is suggested. It is also suggested that sexual activity be avoided.


8. Question: When will I be able to resume sexual activity?
Answer: Sexual activity can be gradually resumed two weeks after surgery.


9. Question: Can I ride a bike or a motorcycle immediately after the surgery?
Answer: Yes.


10. Question: What kinds of foods and drinks should be avoided after the surgery?
Answer: None.

Up-to-date to 12-31-2015

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