男性硬化性苔藓样尿道狭窄的诊治策略

Strategies for the diagnosis and management of male lichen sclerosus urethral stricture

硬化性苔藓样变(LS)是发生于患者生殖器区域的瘢痕性皮肤病,治疗不及时会导致尿道外口狭窄,进而发展至部分或全尿道狭窄,甚至癌变。由于患者及临床医师对该病认识不足,复杂尿道狭窄的病例日益增多,这类患者病情复杂、手术并发症多,治疗决策选择存在诸多争议。本文结合近年相关文献,首先简述了LS的流行病学、典型临床表现、鉴别诊断,并提到本病与阴茎癌的关系。随后详述了LS男性尿道狭窄的主要治疗方式,包括类固醇、免疫调节抑制剂等药物局部治疗,尿道扩张、居家清洁导尿等非手术疗法,以及手术干预方法。在此基础上,本文对于临床上关于LS尿道狭窄手术治疗的争议和进展进行了深入阐述。

Lichen sclerosus(LS)is a scarring skin disease that primarily affects the genital area,which often leads to stricture of the external urethral orifice,and progresses to partial or total urethral stricture and even squamous cell carcinoma when treatment is inadequate.Owing to the lack of awareness of this disease among patients and clinicians,there is an increasing number of cases of complex urethral stricture.The choice of therapeutic decision is controversial because of the complexity of the illness and the large number of surgical complications.Based on the literature in recent years,this article first briefly describes the epidemiological characteristics,typical clinical manifestations,and differential diagnosis of male LS,and explores the relationship between this disease and penile cancer.Next,this article details the main treatment methods for urethral stricture in men with LS,including non-surgical treatment(topical treatment with steroids,immunomodulators,urethral dilation,home cleaning catheterization,etc.)and surgical treatment.As a focus,this article delves into several controversial issues that arise in the clinical discussion of the surgical treatment of this disease.