One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis.

Abstract

PURPOSE\nPerforming one-stage urethroplasty in patients with urethral strictures caused by lichen sclerosis (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following one-stage buccal mucosal graft (BMG) urethroplasty in LS patients, to determine the impact of surgical technique on recurrence and to compare recurrence risk between LS and non-LS patients after one-stage repairs.\n\n\nMATERIALS AND METHODS\nA systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. Twenty-one studies were included, of which 15 provided data for comparative analyses.\n\n\nRESULTS\nPooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI: 6% - 14%). Among studies with longer follow-up (≥24-months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p=0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between LS and non-LS patients (p=0.36). However, across only long-term studies, recurrence risk was significantly higher for LS patients (OR 1.83, p=0.05).\n\n\nCONCLUSIONS\nOne-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures, however high-quality data is limited. Future multi-institutional, long-term prospective studies are needed to assess durability of one-stage repair.