Obstructive complications of lichen sclerosus

Abstract 

Objective

Young males with lichen sclerosus (LS) commonly present with phimosis; complete urinary obstruction has also been described in this population, but is much rarer. We present the case report of a boy with acute renal failure secondary to urethral obstruction caused by LS, with a review of the literature regarding the occurrence of complete urinary obstruction and renal failure associated with this disease process.

Materials and methods

A comprehensive review of the literature was conducted using MEDLINE^® and EMBASE to characterize the association of lichen sclerosus with significant obstructive complications of the urinary tract.

Results

The true incidence of LS is unknown. Reported rates have ranged from 10% to 95% of boys presenting with phimosis. Our review identified 14 cases of complicated urinary obstruction (seven in children) and two cases of renal failure secondary to lichen sclerosus (both in boys).

Conclusions

Distinctive features make this inflammatory process identifiable to the astute physician, such that new onset of phimosis in a school-age boy should raise clinical suspicion of the diagnosis. Successful outcomes, with medical and/or surgical therapy, are commonplace in this cohort. If undiagnosed, however, progression of LS can lead to significant morbidity in the form of renal failure.

Keywords: Lichen sclerosus, Balanitis xerotica obliterans, Phimosis, Meatal stenosis, Renal failure, Boys