Lichen sclerosis is surgical disease by Dr Pankaj Joshi

Lichen sclerosis is a genital skin disease that involves discoloration of the glans and the prepuce. Many patients have lichen sclerosis restricted only to the region of the glans and prepuce. However, a few patients can develop urethral strictures that extend into the penile urethra, bulbar urethra, or even cause panurethral stricture. Genital lichen sclerosis can be detected during a routine follow-up in the clinical OPD. If active lichen sclerosis is present, steroid applications can be administered. Occasionally, circumcision can halt the progression of lichen sclerosis into the urethra. Once the condition reaches the burnt-out stage, steroids are no longer effective.

For penile strictures, we perform a Kulkarni urethroplasty using a perineal incision, penile invagination, one-sided dissection, and buccal graft urethroplasty. We use the same technique for managing lichen sclerosis-associated panurethral strictures. Bulbar strictures require either dorsal or ventral buccal graft augmentation urethroplasty.

Since lichen sclerosis is a genital skin disease, we cannot perform staged surgery as it would result in the genital skin turning into the urethra, causing recurrence. Rarely, lichen sclerosis can progress to malignancy, so careful monitoring of the lesions is necessary.