Long-term Outcomes of Conservative Management for Lichen Sclerosus Urethral Stricture Disease to ensure consistency

To examine the long-term outcomes of conservative management of lichen sclerosus-induced urethral stricture disease (LS-USD).

We retrospectively reviewed charts of patients with LS-USD treated conservatively with endoscopic intervention (eg, dilation, urethrotomy) and/or CIC +/- intraurethral steroids, between 2005 and 2024. Failure of conservative management (CM) was defined as the need for reconstructive surgery or chronic catheter. Patient demographics, medical history, and objective stricture data were collected. Statistical analysis included Kruskal-Wallis, ANOVA, chi-square, Fisher's exact test, and Kaplan-Meier survival curves.

111 patients started CM for LS-USD with a median follow-up of 68.5 months (range 1-237 months). 29 (26.1%) patients failed treatment-8.5% within 2 years and 13.6% within 5 years. The median time to failure was 61 months, with 24% failing by 1 year, 55% by 5 years, and the latest failure at 17 years. Failure was more common in patients with posterior urethral involvement and obliterative stricture features. The most common reasons for failure of CM included persistent bothersome lower urinary tract symptoms (34%), development of acute urinary retention (24%), concomitant buried penis repair (10%), and recurrent urinary tract infections (10%).

Although the majority of patients respond well to CM within the first two years, long-term monitoring is essential due to the progressive risk of treatment failure over time.