Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

BACKGROUND: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture. METHODS: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008–2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments. RESULTS: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. 38.4 months). Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs. 2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis. CONCLUSIONS: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.