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The buccal belt: a buccal mucosal graft sub-coronal resurfacing for recurrent penile adhesions in patients with lichen sclerosus

  • Urology - Original Paper
  • Published:
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Abstract

Background

Penile adhesions may cause pain, bleeding, disfigurement and distress. In the setting of lichen sclerosus (LS), they often recur but current treatment options are limited. We present a novel surgical technique for treatment of recurrent penile adhesions using sub-coronal buccal mucosal graft (BMG) resurfacing.

Methods

A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. Patients with > 12-month follow-up were included in analysis. The procedure involved circumferential excision of the diseased skin and replacement with a BMG. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcome measures (PROMs) including Sexual Health Inventory for Men (SHIM) questionnaire and Global Response Assessment (GRA) questionnaire measuring functional and esthetic outcomes.

Results

Twenty-five men underwent the procedure across six institutions between 3/2014 and 11/2019. Twenty-one men met inclusion criteria. Mean operative time and hospital stay for sub-coronal resurfacing were 40 min (25–50) and 0.76 days (1–2), respectively. At the mean follow-up of 18 months (12–61), no patients developed recurrence. All patients who presented with pain and postcoital bleeding saw improvement on follow-up (18/18). There was a significant improvement in SHIM scores after the operation (14.4 pre-op, 17.0 post-op; p = 0.003). Overall improvement of symptoms was reported by all patients: 57% GRA + 3; 29% GRA + 2; 14% GRA + 1. Baseline penile sensation was preserved in 17/21 (81%) patients.

Conclusions

Recurrent penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction.

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Authors and Affiliations

  1. Department of Urology, SUNY Upstate Medical University, Syracuse, USA

    Matthew Beamer & Dmitriy Nikolavsky

  2. Departemento Clinico, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain

    Javier C. Angulo

  3. Departamento de Urología, Centro de Educación Medica E Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina

    Leandro Capiel

  4. Hospital Regional Lic. Adolfo Lopez Mateos, Mexico City, Mexico

    Damian López-Alvarado

  5. Centro de Uretra Las Almeda, Mexico City, Mexico

    Erick A. Ramirez

  6. Medical Faculty, Saiful Anwar General Hospital, Brawijaya University, Malang, Indonesia

    Paksi Satyagraha

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  1. Matthew Beamer
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  2. Javier C. Angulo
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Correspondence to Dmitriy Nikolavsky.

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Beamer, M., Angulo, J.C., Capiel, L. et al. The buccal belt: a buccal mucosal graft sub-coronal resurfacing for recurrent penile adhesions in patients with lichen sclerosus. Int Urol Nephrol 52, 1491–1497 (2020). https://doi.org/10.1007/s11255-020-02437-7

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