Open Access

ARTICLE

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

Bradley A. Erickson¹, Brennan A. Tesdahl¹, Maria A. Voznesensky¹, Benjamin N. Breyer², Bryan B. Voelzke³, Nejd F. Alsikafi⁴, Alex J. Vanni⁵, Joshua A. Broghammer⁶, Jill C. Buckley⁷, Jeremy B. Myers⁸, William O. Brant⁸, Lee C. Zhao⁹, Thomas G. Smith III¹⁰, Brian L. Swick¹, Laila Dahmoush¹

1 Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
2 Department of Urology, University of California, San Francisco, California, USA
3 Department of Urology, University of Washington, Seattle, Washington, USA
4 Uropartners, Gurnee, Illinois, USA
5 Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
6 Department of Urology, University of Kansas, Kansas City, Kansas, USA
7 Department of Urology, University of California, San Diego, California, USA
8 Division of Urology, University of Utah, Salt Lake City, Utah, USA
9 Department of Urology, New York University, New York, New York, USA
10 Department of Urology, Baylor College of Medicine, Houston, Texas, USA
Address correspondence to Dr. Bradley A. Erickson, Department of Urology, University of Iowa, 3233 RCP, 200 Hawkins Drive, Iowa City, IA 52242 USA

Canadian Journal of Urology 2018, 25(3), 9328-9333.

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 pathologists (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 DP 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 improved treatments.

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