Lichen sclerosus and isolated bulbar urethral stricture disease
Reviewed by Xi Cheng

The incidence of urethral stricture in men with lichen sclerosus (LS) has been reported to be between 4.8% and 14%. LS limited to the glans and urethral meatus can be treated with acceptable outcomes; however, more extensive urethral disease requires invasive options such as urethroplasty. The authors feel that the prevalence of LS leading to isolated bulbar urethral stricture disease has been under-reported. A retrospective study was performed of 70 patients who underwent urethroplasty for isolated bulbar urethral stricture disease between 2007 and 2013. Patients with less than one year follow-up, previous urethral injury, urethral disruption or tear, pelvic fractures and previous LS affecting areas distal to penile, urethra and meatus were excluded. Patient demographics, co-morbidities, past medical / surgical histories were also collected. Initial pathological finding of the specimens were obtained from electronic medical records and reviewed. The surgical specimens were reviewed by a uro-pathologist who was blinded to the initial diagnosis and patient history. Five common histological features of LS were used to aid diagnosis: 1) hyperkeratosis, 2) epidermal / squamous epithelium thinning or thickening, 3) basal cell layer attenuation or vacuolar degeneration, 4) subepithelial hyalinisation / dermal collagen homogenisation and 5) lichenoid lymphocytic or plasmacytic infiltrate. Specimens with two of the five were considered to be suggestive of LS whereas specimens with three or more of the five were considered to be LS positive. Initially 5/70 patients had LS involvement; using the pathological criteria, the study has found a statistically significant increase to 31/70 patients (p=0.0001). The authors have also reported a high rate of disease recurrence in the LS group (83.3%) vs. non-recurrence (40.6%). Although LS may not be solely responsible for the development of a clinically significant stricture, the knowledge of its involvement can influence the treatment options offered to the patient, hence early detection is important. 

Lichen sclerosus and isolated bulbar urethral stricture disease.
Liu JS, Walker K, Stein D, et al.
THE JOURNAL OF UROLOGY
2014;192(3):775-9. UPLOADED