A new technique for meatal stenosis in patients with lichen sclerosus.

Abstract

A novel technique is described to relieve stenosis of a ventrally placed or pinhole external urinary meatus in men and boys with lichen sclerosus. A total of 19 patients underwent the new operation in a 5-year period. Mean patient age was 42.2 years (range 6 to 74) and mean followup was 3 years 9 months (range 18 months to 6 years 7 months). The operation involves dorsal and ventral meatotomies with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the cosmetic results, and how often and how much they sprayed when passing urine. Two patients died of unrelated causes and 2 were lost to followup. There were no recurrences or major complications. A total of 13 patients replied to the questionnaires. All patients were pleased or very pleased with the cosmetic result. Most patients (11 of 13 or 85%) did not spray at all or, if they did, only sprayed occasionally. No patient found it constant or severe. The technique relieves stenosis of the external urinary meatus in the medium term. It is rapid and easy to perform on an outpatient basis and it provides good cosmesis with a low incidence of a spraying stream. Because the main axis of the operation is dorsal, it does not create a hypospadiac meatus.