Lichen Sclerosus in Patients Undergoing Adult-Acquired Buried Penis Repair: A Large Cohort Review

To better define the prevalence of lichen sclerosis (LS) and urethral stricture disease in men with adult-acquired buried penis (AABP) given a known association but that previous reports have been highly variable. Here, we utilize a large cohort of buried penis patients to describe the prevalence of lichen sclerosus and other histopathological findings and their relation to urethral stricture disease.

Preoperative characteristics and histopathological data for patients who underwent buried penis repair or penectomy in the setting of buried penis at our institution between 2015 and 2024 were retrospectively reviewed. Tissue specimens with equivocal findings of inflammation on the initial report underwent secondary review by a genitourinary pathologist. The rate of concomitant urethral stricture disease was also assessed.

We included 180 patients in our final cohort. Of these, 23% were found to have LS on final pathology. Penile cancer was present in 5% of patients. Patients with LS were 2.3 times more likely to require surgical intervention for urethral stricture disease (54.8% vs 23.8%). Of patients requiring stricture intervention, those with LS were 1.72 times more likely to require an open surgical intervention and 3.07 times more likely to require endoscopic intervention.

Patients with buried penis suffer from high rates of LS and associated urethral stricture. These findings highlight the need for urethral and penile surveillance in patients with AABP and adverse pathologic skin changes and underscore the importance of thorough patient counseling prior to operative intervention.