clobetasol and Urethral-Stricture

We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery.. We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively.. We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4).. Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.

Topics: Administration, Topical; Adult; Biopsy; Clobetasol; Follow-Up Studies; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Reported Outcome Measures; Patient Satisfaction; Penis; Prospective Studies; Quality of Life; Retrospective Studies; Skin Cream; Treatment Outcome; Urethra; Urethral Stricture; Urination

Several factors such as genetic susceptibility, autoimmunity, hormones, infections, local trauma, urine, and occlusion have been speculated to play a role in the pathogenesis of lichen sclerosus. We report two male patients with lichen sclerosus around 'ectopic' urethral openings and the opposing surfaces of the penile shaft and scrotum, providing further evidence in support of urine and occlusion as contributing factors in the development of lichen sclerosus.

Topics: Aged; Anti-Inflammatory Agents; Biopsy; Clobetasol; Humans; Lichen Sclerosus et Atrophicus; Male; Penis; Treatment Outcome; Urethra; Urethral Stricture; Young Adult

We investigated outcomes of the contemporary practice of administering intraurethral steroids to treat stricture disease in patients with biopsy proven lichen sclerosus.. We performed an institutional review board approved review of the records of patients with biopsy proven lichen sclerosus stricture disease from October 2010 to September 2015. Study inclusion criteria were age 18 years or greater and male gender. Extracted data included patient demographics, comorbidities, location of lichen sclerosus, previous therapies and need for further interventions. Management was considered successful when there was no need for subsequent escalation of therapy. The intraurethral steroid regimen consisted of applying clobetasol cream to the affected urethra to lubricate a calibration device such as a urinary catheter or meatal dilator. The initial phase of therapy included twice daily application for 2 to 3 months, at which point the frequency was decreased by the clinician, enabling the patient to titrate medication use as needed.. We identified 40 patients with biopsy proven lichen sclerosus who had urethral stricture as part of the disease state. Of these patients 28 received the intraurethral steroid regimen and success was achieved in 25 (89%). Mean followup was 24.8 months. No patient who was started on the intraurethral steroid regimen proceeded to urethroplasty.. Based on our outcomes we have developed a stepwise treatment algorithm for patients with biopsy proven lichen sclerosus stricture disease that uses intraurethral steroids before initiating plans for invasive surgery.

Topics: Administration, Topical; Clobetasol; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture

When not recognized and treated aggressively, lichen sclerosus may progress and cause debilitating symptoms. It also may result in significant morbidity in patients undergoing treatment for urethral strictures because unrecognized, it may result in rapid and severe recurrence after surgical treatment. We present our experience treating patients with lichen sclerosus in an equal access health care system.. We performed an institutional review board approved retrospective review of all adult men with lichen sclerosus treated at our institution during a 10-year period. We analyzed all patients diagnosed with lichen sclerosus, and recorded patient demographics and therapies. We recorded characteristics of the disease process including external and internal manifestations. We also recorded the various treatments, and whether the patients experienced recurrence.. A total of 43 patients were diagnosed with lichen sclerosus during the review period. Of those patients presenting with more severe (urethral) involvement and undergoing 1 or 2-stage urethroplasties, we noted 7 with recurrence. In the remainder of patients presenting with less severe disease who were treated aggressively with clobetasol and/or minor procedures, no recurrences were noted on followup examination, and all of these patients had documented normal flow patterns on noninvasive urodynamics.. Our data suggest that early aggressive topical therapy plus minimally invasive surgical therapy to relieve high pressure voiding may prevent the progression of lichen sclerosus in patients who present with limited disease involving the skin and meatus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Clobetasol; Disease Progression; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Urethral Stricture; Young Adult