Urethral lichen sclerosus under the microscope: a survey of academic pathologists.

Authors

Bradley A Erickson
Brennan A Tesdahl
Maria A Voznesensky
Benjamin N Breyer
Bryan B Voelzke
Nejd F Alsikafi
Alex J Vanni
Joshua A Broghammer
Jill C Buckley
Jeremy B Myers
William O Brant
Lee C Zhao
Thomas G Smith Iii
Brian L Swick
Laila Dahmoush

Publication/Presentation Date

6-1-2018

Abstract

INTRODUCTION: Given the poor understanding of the pathophysiology of genital lichen sclerosus (GLS) and a lack of accepted definitive diagnostic criteria, we proposed to survey pathologists regarding their understanding of GLS. We hypothesized that significant disagreement about GLS will exist.

MATERIALS AND METHODS: All urologists participating in the Trauma and Urologic Reconstruction Network of Surgeons identified genitourinary (GUP) and dermatopathologists (DP) at their respective institutions who were then invited to participate in an online survey regarding their experience with diagnosing GLS, GLS pathophysiology and its relationship to urethral stricture disease.

RESULTS: There were 23 (12 DP, 11 GUP) pathologists that completed the survey. The most agreed upon criteria for diagnosis were dermal collagen homogenization (85.7%), loss of the normal rete pattern (33.3%) and atrophic epidermis (28.5%). No pathologists believed GLS had an infectious etiology (19% maybe, 42% unknown) and 19% believed GLS to be an autoimmune disorder (42% maybe, 38% unknown); 19% believed LS to be premalignant, but 52% believed it was associated with cancer; 80% believed that LS could involve the urethra (DP (92%) versus GUP (67%); p = 0.272). Of those diagnosing urethral GLS, 80% of DUP believed that GLS must first involve the glans/prepuce before involving the urethra, while all GUP believed that urethral disease could exist in isolation (p = 0.007).

CONCLUSIONS: There was significant disagreement in this specialized cohort of pathologists when diagnosing GLS. A logical first step appears to be improving agreement on how to best describe and classify the disease. This may lead to improve treatments.

Volume

25

Issue

3

First Page

9328

Last Page

9333

ISSN

1195-9479

Published In/Presented At

Erickson, B. A., Tesdahl, B. A., Voznesensky, M. A., Breyer, B. N., Voelzke, B. B., Alsikafi, N. F., Vanni, A. J., Broghammer, J. A., Buckley, J. C., Myers, J. B., Brant, W. O., Zhao, L. C., Smith Iii, T. G., Swick, B. L., & Dahmoush, L. (2018). Urethral lichen sclerosus under the microscope: a survey of academic pathologists. The Canadian journal of urology, 25(3), 9328–9333.

Disciplines

Medicine and Health Sciences

PubMedID

29900821

Department(s)

Department of Medicine

Document Type

Article