Lichen sclerosus associated urethral disease: reconstructive strategy and medical adjuncts

PURPOSE OF REVIEW: Lichen sclerosus associated urethral stricture disease represents a complex and evolving reconstructive challenge due to its heterogeneous presentation, progressive course, and persistent long-term risk of recurrence. This review summarizes contemporary reconstructive strategies and adjunctive therapies, highlighting recent refinements and ongoing limitations in the available evidence. RECENT FINDINGS: Recent data demonstrate a shift toward single-stage, anatomy-based urethral reconstruction in selected patients with lichen sclerosus, particularly using oral mucosa grafts, while emphasizing the need for segment-specific approaches for distal, penile, and panurethral strictures. Despite these advances, high-quality comparative evidence remains limited, with most studies being retrospective and heterogeneous in design and outcome reporting. A consistent finding across the literature is the clear contraindication to the use of genital skin grafts in lichen sclerosus. Advances in stricture classification systems, outcome assessment tools, and patient-reported measures have improved patient counseling and facilitated more standardized reporting. Topical therapies may play an adjunctive role, whereas systemic treatments remain investigational. SUMMARY: Management of lichen sclerosus associated urethral stricture disease requires individualized, segment-specific reconstructive strategies and long-term surveillance. While recent refinements support selected single-stage approaches, further prospective, lichen sclerosus specific studies with standardized outcomes are needed to inform evidence-based recommendations.