Urethral lichen sclerosus under the microscope: a survey of academic pathologists.

INTRODUCTION: Given the poor understanding of the pathophysiology of genital lichen sclerosus (GLS) and a lack of accepted definitive diagnostic criteria, we proposed to survey pathologists regarding their understanding of GLS. We hypothesized that significant disagreement about GLS will exist. MATERIALS AND 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 GLS, GLS pathophysiology and its relationship to urethral stricture disease. RESULTS: There were 23 (12 DP, 11 GUP) pathologists that completed the survey. 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%). 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%) versus 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). 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. This may lead to improve treatments.

Patient-Reported Social, Psychological, and Urologic Outcomes After Adult Buried Penis Repair.

OBJECTIVE: To assess changes in hygiene, urination, and sexual activity after surgery for adult-acquired buried penis. MATERIALS AND METHODS: The study included men who underwent buried penis repair from 2011 to 2015. Patients were asked pre- and postoperative questions on hygiene, urinary difficulties, sexual difficulties, and difficulties with activities of daily living (modified Post-Bariatric Surgery Quality of Life Questionnaire). Postoperative satisfaction was assessed at a minimum of 6 months. Pre- and postoperative data were compared with chi-squared analyses. RESULTS: Of 14 eligible patients, 12 completed postoperative questionnaires. Buried penis repair required debridement of penile skin with split-thickness skin grafting to penis (n = 11; 92%), escutcheonectomy (n = 12; 100%) and abdominoplasty (n = 10; 83%), scrotoplasty (n = 7; 59%), and securing the supra-penile dermis to the pubic dermal or periosteal tissue (n = 12, 100%). The average length of follow-up was 31 months (±20 months). Mean age was 50 (±10.5 years) and mean body mass index was 55 (±13.7 kg/m2). Wound complications (all Clavian Grade 1) occurred in 9 of 12 patients. Patients reported improvement in hygiene (100%), urination (91%), and sexual function (41%); 92% of patients reported they would choose to have the surgery again; and 83% felt that surgery had led to a positive change in their lives. The ability to perform most activities of daily living, as assessed by the Post-Bariatric Surgery Quality of Life Questionnaire, improved significantly. Over 90% of men had lost additional body weight at last clinical follow-up. CONCLUSION: Buried penis repair positively impacts social, psychological, and functional outcomes for patients. Wound complications should be expected but are easily managed.

Malignant peripheral nerve sheath tumor of the renal pelvis.

Malignant peripheral nerve sheath tumors (MPNST) of the urothelial collecting system are rare. These tumors contain both malignant epithelial and sarcomatous components. Metastatic spread of MPNST is common, however, metastases to the kidney and perirenal tissues are rare. There are only 4 cases reported of MPNST of the kidney. We report a rare case of MPNST arising from the submucosa of the renal pelvis.