Introduction

Lichen sclerosus (LS) is an inflammatory dermatologic condition that involves squamous epithelium. Genitourinary LS (GLS), historically known as balanitis xerotica obliterans (BXO), is thought to involve the urethra, a stratified/pseudostratified columnar and urothelial lined organ. Given the poor understanding of the pathophysiology of LS and a lack of accepted definitive diagnostic criteria, we proposed to survey pathologists regarding their understanding of LS. We hypothesized that significant disagreement about GLS will exist.

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 LS, LS pathophysiology and its relationship to urethral stricture disease. Statistical comparisons between responses provided by DPs and GUPs were performed using the Fischer’s exact test.

Results

There were 23 (12 DP, 11 GUP) pathologists that completed the survey. Overall, 90% still use BXO when describing GLS and 66% require a clinical history. 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%) - thus no single criteria was deemed necessary for diagnosing GLS by all pathologists. Only 1 pathologist routinely graded GLS severity. The average number required findings for diagnosis was 2.1±1.09 (GUP 2.1±1.27 v DP 2.1±1.0; p = 0.96). 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%) v 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)._x000D_

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 and characterize possible differences in histological changes between skin and GLS. Specialty-wide efforts to routinely collect and analyze urethral stricture specimens may aid in understanding pathophysiologies that continue to elude urologists and pathologists. _x000D_ _x000D_ _x000D_

Funding

None