Review of the male genital lichen sclerosus and urethral involvement

Lichen sclerosus (LS) previously known as balanitis xerotica obliterans, is a chronic, progressive lymphocyte mediated skin disease. It shows a predilection for the male genital area and may involve in external urinary meatus, penile urethra and even bulbar urethra causing stricture. Male genital lichen sclerosus (MGLSc) may lead to a significant impairment of urinary and sexual function; and it has also been associated with a risk of malignant transformation. The epidemiology, natural history, histological features and possible aetiology of this disease have been researched in recent years. The direct relationship between MGLSc and penile squamous cell carcinoma (SCC) remains to be established. Biopsy of the initial lesion for definitive diagnosis and long-term follow up of affected patients are well established. The aetiology of the disease is incompletely characterized to date. The goals of the treatment are to alleviate symptoms and discomfort, prevent anatomical changes such as urethral stricture and prevent malignant transformation. Topical corticosteroid and circumcision can be curative if the disease is treated early when still localized. Severe MGLSc and urethral involvement may require extensive treatment. Various surgical procedures like simple meatotomy, staged urethroplasty using oral mucosa and complicated urethral reconstruction have been widely used depending on the length and severity of urethral stricture. Biopsy and long-term surveillance are recommended. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.