Study of Intraurethral Instillation of Tacrolimus for Urethral Involvement Following Lichen Sclerosus
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 4
Abstract
Introduction: Lichen sclerosus (LS) is a lymphocyte-mediated inflammatory process that in men affects the genital skin and also the urethra, causing urethral stricture. Formerly known as balanitis xerotica obliterans, LS is the most common cause of long panurethral stricture in males. Medical management of LS in the form of topical steroids, immunomodulators like tacrolimus, and systemic retinoid acitretin have been described for diseases involving the prepuce and glans. Urethral involvement usually requires surgical intervention. This study was done to assess the efficacy of intraurethral instillation of tacrolimus as a nonsurgical modality. Materials and Methods: Type of study: This is a prospective nonrandomized observational study. The study included 20 men with histology proven genital LS with variable length of anterior urethral involvement proximal to fossa navicularis. Pretreatment uroflowmetry and ultrasonography were done for flow and post-void residual urine status. All the patients underwent suprapubic cystostomy before therapy, for longer intraurethral dwell time of tacrolimus. Patients also underwent meatotomy for associated meatal stenosis. 1 g of 0.03% tacrolimus was instilled intraurethrally twice a day for 6 weeks. Reassessment was done at 6 weeks and 12 weeks. Results: A total of 15 patients (75%) responded favorably to the treatment with significant improvement at 6 weeks sustained at 3 months. Four patients did not respond to the treatment. One patient showed objective and subjective improvement but found the process cumbersome and opted for Urethroplasty. The most common patient’s complaint was of urethral discomfort and perineal heaviness for the initial few days, which subsided on its own. Discussion: Intraurethral instillation of tacrolimus provides a minimally invasive tool for management of one of the difficult urethral strictures to treat. The treatment modality fulfills the three basic goals of urethral stricture management - unobstructed voiding, painless intercourse, and good cosmesis.
Authors and Affiliations
Ranjan K Dey, Imran Khan, Dawood Khan
Keywords
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