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What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review

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Abstract

Purpose

The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given.

Materials and methods

To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed.

Results

Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65–100% (mean/median follow-up, 12–59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL.

Conclusions

The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit–harm balance and surgeon’s skills and expertise, single-stage OMGU can be justified in patients with LS strictures.

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Author notes

  1. Francesco Esperto and Wesley Verla are joint first authors.

Authors and Affiliations

  1. Department of Urology, Campus Biomedico University of Rome, Via Álvaro Del Portillo, 200 00128, Rome, Italy

    Francesco Esperto

  2. Division of Urology, Gent University Hospital, Gent, Belgium

    Wesley Verla, Nicolaas Lumen & Marjan Waterloos

  3. Department of Urology, Athens Medical Centre, Athens, Greece

    Achilles Ploumidis

  4. Department of Urology, University College London Hospital, London, UK

    Rachel Barratt & Tamsin Greenwell

  5. Department of Urology, University of Naples Federico II, Naples, Italy

    Roberto La Rocca

  6. Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada

    Yuhong Yuan

  7. Urology Department, Marques de Valdecilla University Hospital, Santander, Spain

    Felix Campos-Juanatey

  8. Department of Urology, Santa Maria University Hospital, University of Lisbon, School of Medicine, Lisbon, Portugal

    Francisco Martins

  9. Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK

    Nadir Osman

  10. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Silke Riechardt

  11. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK

    Konstantinos Dimitropoulos

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  1. Francesco Esperto
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Correspondence to Francesco Esperto.

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Esperto, F., Verla, W., Ploumidis, A. et al. What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review. World J Urol 40, 393–408 (2022). https://doi.org/10.1007/s00345-021-03803-5

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  • DOI: https://doi.org/10.1007/s00345-021-03803-5

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