Modern approach to the treatment of lichen sclerosus and its complications.
Authors:   Department of Urology and Andrology of Pirogov Russian National Research Medical University, Kotov S.V. ,   Moscow, Russia, Alekberov E.M. ,   the Department of Urology and Andrology N.I. Pirogov Russian National Research Medical University; Moscow, Russia, Iritsyan M.M. ,   the Department of Urology and Andrology N.I. Pirogov Russian National Research Medical University; Moscow, Russia
Published: February 2024

Introduction. One of the reasons for the development of urethra stricture in men is Lichen sclerosis, and its role in the development of panurethral narrowing of the urethra comes to the fore. With timely diagnosis and adequate treatment, it is possible to anticipate the development of complications of this disease. At the moment, there are a large number of approaches to the treatment of lichen sclerosis and its complications. Purpose. To study and summarize the currently available options for treatment of lichen sclerosis and its complications, as well as to determine the vector of further research. Materials and methods. The search results were analyzed in the scientific databases eLibrary, PubMed, according to the following. keywords: «lichen sclerosus», «urethral stricture», «meatal stenosis». The search was carried out regardless of the date and language of publication. After analyzing the literature, 47 works were selected for review that most fully reflect the topic of diagnosis and treatment of lichen sclerosis and its complications. Results. Lichen sclerosus is a complex, recurrent disease, the etiology of which is currently not completely clear. It is clear that patients require careful monitoring during and after treatment, since the disease is chronic and relapsing. This article presents research data on the safety and effectiveness of various methods of treating lichen sclerosus: from topical application of topical glucocorticosteroids, calcineurin inhibitors and retinoids to multi-stage urethroplasty. It has been shown that with timely treat-ment and timely prescribed conservative therapy, the likelihood of relief of clinical symptoms and absence of disease progression is quite high. If the urethra is involved in the process, it is necessary to resort to surgical intervention, and the method of treatment is determined individually and depends on the clinical picture and extent of the disease. Thus, if the external opening of the urethra is damaged, classical meatotomy does not bring the desired clinical effect, which is why it is necessary to resort to the original Malone technique. For strictures of the penile and bulbous urethra, good results are shown by single- and multi-stage urethroplasty using the oral mucosa. In some severe cases, the operation of choice is perineostomy. Conclusion. Lichen sclerosus is a serious problem leading to a decrease in the quality of life of patients. Treatment of lichen sclerosus requires an integrated approach with the participation of dermatologists and urologists, which can improve the effectiveness of treatment for patients with both isolated lesions of the foreskin and involvement of the urethra.