Kulkarni Sanjay, Barbagli Guido, Kirpekar Deepak, Mirri Francesco, Lazzeri Massimo
Center for Reconstructive Urethral Surgery, Pune, India.
Eur Urol. 2009 Apr;55(4):945-54. doi: 10.1016/j.eururo.2008.07.046. Epub 2008 Jul 30.
Surgical options in male patients with genital lichen sclerosus (LS) involving the anterior urethra still represent a challenging issue.
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.
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).
Primary outcome was considered a failure when any postoperative instrumentation was needed, including dilation, or when recurrence was diagnosed.
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.
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.
对于患有累及前尿道的男性生殖器硬化性苔藓（LS）患者，手术选择仍是一个具有挑战性的问题。
回顾生殖器和尿道LS患者的手术治疗结果。
设计、地点和参与者：在两个专业中心进行的多中心、国际性、回顾性、观察性描述性研究。215例男性患者因组织学证实的累及包皮和/或前尿道的生殖器LS接受了手术。
包皮环切术（34例）、尿道口切开术（15例）、包皮环切术和尿道口切开术（8例）、一期阴茎口腔黏膜移植尿道成形术（8例）、二期阴茎口腔黏膜移植尿道成形术（15例）、一期球部口腔黏膜移植尿道成形术（88例）和确定性会阴尿道造口术（47例）。
当需要任何术后器械操作（包括扩张）或诊断为复发时，主要结局被视为失败。
平均随访时间为56个月（范围：12 - 170个月）。包皮环切术成功率为100%，疾病无复发；尿道口切开术成功率为80%；包皮环切术和尿道口切开术成功率为100%；一期阴茎口腔黏膜移植尿道成形术成功率为100%；二期阴茎口腔黏膜移植尿道成形术成功率为73%；一期球部口腔黏膜移植尿道成形术成功率为91%；确定性会阴尿道造口术成功率为72%。局限性包括记录肿瘤变性的随访时间短，且没有调查生活质量的工具。
局限于包皮和/或尿道外口的LS疾病患者手术成功率较高。对于阴茎尿道狭窄或全尿道狭窄患者，使用一期口腔黏膜移植尿道成形术比分期手术成功率更高。
