Conservative Management of Lichen Sclerosus Male Urethral Strictures: A Multi-Institutional Experience.

Abstract Objectives To assess the outcomes and safety of conservative management of lichen sclerosus urethral stricture disease (LS-USD). Methods This multi-institutional study included patients with LS-USD managed with endoscopic procedures or clean intermittent catheterization (CIC) regimens between 2005-2019. Those with an obliterative stricture, a history of prior urethral reconstruction, or Results 112 men were analyzed with a median follow-up of 30.0 months (IQR 12.0-55.5). Median age was 52.5 years (IQR 42.6-61.0) and median body mass index was 34.5 kg/m2 (IQR 29.9-40.7). Median stricture length was 12.0 cm (IQR 2.8-20.0). 89% of patients underwent urethral balloon dilation, with a median of 2 (IQR 1-3) per patient. CIC was performed in 46% of patients, with 31% of this subgroup using intraurethral steroids. 84% of patients avoided invasive surgery or permanent indwelling catheterization, with an improvement in urethral stricture PROM scores (p=0.0013). Those who failed were more likely to have a history of UTI (p=0.04), urosepsis (p=0.03), AUR (p Conclusions Over medium-term follow-up, most patients with LS-USD were safely managed with conservative techniques. Caution is warranted in those who develop UTIs, urosepsis, and AUR and the potential long-term consequences of repetitive conservative interventions must be considered.