Русский
A comprehensive approach to the treatment of urethral strictures caused by lichen sclerosus
DOI: https://dx.doi.org/10.18565/urology.2021.4.12-18
A.C. Usupbaev, R.M. Kurbanaliev, S. Akylbek, I.V. Kolesnichenko, N.Z. Sadyrbekov
1) Department of «Urology and Andrology of pre- and post-graduate studies named by M. T. Tynaliev» of the Kyrgyz State Medical Academy named by I. K. Akhunbaev, Bishkek, Kyrgyzstan; 2) clinic KRAUS, Bishkek, Kyrgyzstan; 3) Department «Urology» of the Kyrgyz-Russian Slavic University named by B. N. Yeltsin, Bishkek, Kyrgyzstan; 4) Republican Scientific Center of Urology at the National Hospital of the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
Aim: to evaluate the correctness of the diagnosis of lichen sclerosus with an evaluation of complications in the form of urethral strictures and to ensure long-term monitoring of patient management in order to avoid recurrence of fibrous complications and ascending infection in case of lower urinary tract obstruction.
Material and methods: a total of 55 men aged from 17 to 85 years with lichen sclerosus complicated by urethral stricture who were treated from 2005 to 2020 were included in the study. All patients underwent a comprehensive urological examination. From them, 18 (32.7%) patients had previously undergone various types of urethral procedures and were admitted with recurrent urethral stricture for repeated surgery.
Results: an examination of patients with lichen sclerosus complicated by urethral strictures is presented, including a morphological assessment of the resected tissue and analysis of etiopathogenetic factors. In addition, the results of complex treatment of patients with urethral strictures associated with sclerosus were evaluated. An increase in the maximum urine flow rate and a decrease in post-void residual volume by almost three times was noted 1-3 months after urethroplasty. After 6 months, a recovery of an adequate micturition and complete absence of residual urine were revealed. The morphological picture in patients with urethral strictures associated with lichen sclerosus is characterized by focal atrophy of the epidermis, replacement of the columnar epithelium with a stratified epithelium with signs of hyperkeratosis and acanthosis, histiolymphocytic infiltration, and the formation of microcalcifications under the basement membrane.
Conclusion: the correctness of the diagnosis verification and the choice of the treatment strategy in patients with urethral strictures caused by lichen sclerosus significantly contributes to the favorable outcomes. Based on comparative analysis, we can conclude than complex approach to the treatment of patients with urethral strictures associated with lichen sclerosus is highly effective.
Material and methods: a total of 55 men aged from 17 to 85 years with lichen sclerosus complicated by urethral stricture who were treated from 2005 to 2020 were included in the study. All patients underwent a comprehensive urological examination. From them, 18 (32.7%) patients had previously undergone various types of urethral procedures and were admitted with recurrent urethral stricture for repeated surgery.
Results: an examination of patients with lichen sclerosus complicated by urethral strictures is presented, including a morphological assessment of the resected tissue and analysis of etiopathogenetic factors. In addition, the results of complex treatment of patients with urethral strictures associated with sclerosus were evaluated. An increase in the maximum urine flow rate and a decrease in post-void residual volume by almost three times was noted 1-3 months after urethroplasty. After 6 months, a recovery of an adequate micturition and complete absence of residual urine were revealed. The morphological picture in patients with urethral strictures associated with lichen sclerosus is characterized by focal atrophy of the epidermis, replacement of the columnar epithelium with a stratified epithelium with signs of hyperkeratosis and acanthosis, histiolymphocytic infiltration, and the formation of microcalcifications under the basement membrane.
Conclusion: the correctness of the diagnosis verification and the choice of the treatment strategy in patients with urethral strictures caused by lichen sclerosus significantly contributes to the favorable outcomes. Based on comparative analysis, we can conclude than complex approach to the treatment of patients with urethral strictures associated with lichen sclerosus is highly effective.
About the Autors
Corresponding author: S. Akylbek – Ph.D. student at the Department of «Urology and Andrology of pre- and postgraduate studies named by M. T. Tynaliev» of the Kyrgyz State Medical Academy named by I. K. Akhunbaev, Bishkek, Kyrgyzstan; e-mail: md.akylbek@gmail.com
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