Desai Devang, Harrison William, Raveenthiran Sheliyan, Samaratunga Hemamali, De Win Gunter
Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia.
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Transl Androl Urol. 2024 Mar 31;13(3):423-432. doi: 10.21037/tau-23-549. Epub 2024 Mar 12.
Lichen sclerosus (LS) is considered a causative factor in 10% of cases of idiopathic urethral stricture disease (IUSD), which is important for determining management strategies due to the underlying pathophysiology. Traditional excision urethroplasty may not be effective as inflammation often extends beyond the macroscopic stricture. This pilot study aims to answer two research questions: is LS an underlying cause of some idiopathic cause of strictures, and, if there is histological evidence suggesting predisposition of the surrounding tissue to strictures.
Biopsies were taken from the stricture site as well as 1 and 2 cm proximal and distal in patients with IUSD. Histological features, including macroscopic and microscopic findings, were reported, including the presence of LS, hyperkeratosis, epidermal changes, lichenoid infiltrates, ulceration, scarring, and inflammation. Methylene blue was used to aid in locating damaged urothelium. Patients were prospectively followed up after urethroplasty.
From 109 urethroplasties performed between 2019 to 2022, 15 male patients were enrolled after meeting specific inclusion criteria. These criteria included a diagnosis of IUSD and the absence of any evidence of trauma, macroscopic inflammatory disease, or previous endoscopic instrumentation of the urethra. Patients had to be at least 16 years old and medically suitable for undergoing urethroplasty. The study was approved by the hospitals ethics committees. None had macroscopic evidence of LS. One patient had microscopic evidence of LS at the 2 cm proximal biopsy only. A total of 93% of patients had scarring proximal and distal to the stricture, while 20-40% had inflammatory change. The patient with microscopic LS and two inflammatory change patients had stricture recurrence after urethroplasty. Additionally, one patient with inflammatory changes was diagnosed with penile intraepithelial neoplasia (PeIN) and underwent partial penectomy.
Findings suggest that an underlying cause of IUSD could be LS. Additionally, the pathophysiology may involve scarring and inflammation beyond the limits of the stricture with extension distal from the stricture site. Careful evaluation for concomitant urethral pathology should be considered in cases of inflammatory changes. These findings should be considered in the surgical management of IUSD and warrant further research into the role of routine biopsy and drug targets in USD.
硬化性苔藓（LS）被认为是10%特发性尿道狭窄疾病（IUSD）病例的致病因素，鉴于其潜在的病理生理学，这对确定治疗策略很重要。传统的切除性尿道成形术可能无效，因为炎症往往超出肉眼可见的狭窄范围。这项初步研究旨在回答两个研究问题：LS是否是某些特发性狭窄病因的潜在原因，以及是否有组织学证据表明周围组织易患狭窄。
对IUSD患者的狭窄部位以及近端和远端1厘米及2厘米处进行活检。报告组织学特征，包括宏观和微观发现，包括LS、角化过度、表皮变化、苔藓样浸润、溃疡、瘢痕形成和炎症的存在。使用亚甲蓝辅助定位受损的尿路上皮。患者在尿道成形术后进行前瞻性随访。
在2019年至2022年期间进行的109例尿道成形术中，15名男性患者在符合特定纳入标准后入组。这些标准包括IUSD的诊断以及无任何创伤、宏观炎症性疾病或先前尿道内镜检查的证据。患者必须至少16岁且在医学上适合接受尿道成形术。该研究获得了医院伦理委员会的批准。没有人有LS的宏观证据。仅1例患者在近端2厘米处活检有LS的微观证据。总共93%的患者在狭窄近端和远端有瘢痕形成，而20 - 40%有炎症变化。有微观LS的患者和两名有炎症变化的患者在尿道成形术后出现狭窄复发。此外，一名有炎症变化的患者被诊断为阴茎上皮内瘤变（PeIN）并接受了部分阴茎切除术。
研究结果表明IUSD的一个潜在原因可能是LS。此外，病理生理学可能涉及超出狭窄范围的瘢痕形成和炎症，从狭窄部位向远端延伸。对于有炎症变化的病例，应考虑仔细评估是否存在并发的尿道病理情况。这些发现应在IUSD的手术管理中予以考虑，并值得进一步研究常规活检和药物靶点在USD中的作用。
