Introduction: Traditionally, two-stage buccal mucosal graft (BMG) repairs were used to treat penile urethral strictures (PUS) related to lichen sclerosus (LS). Recently, indications have expanded for single-stage urethroplasty (SSU) for complex strictures aimed to minimize the risks of a second procedure. Additionally, a perineal urethrostomy is a viable option. The objective of this study is to compare SSU, staged urethroplasty, and perineal urethrostomy for the treatment of LS PUS.

Methods: A single-center, retrospective analysis was performed on patients undergoing urethroplasty for LS PUS from August 2003 to May 2021. Meatal strictures <2 cm and panurethral strictures (>10 cm) involving the bulbar urethra were excluded. Strictures were reconstructed with either SSU, a staged technique, or perineal urethrostomy. Primary outcome was urethral patency at followup cystoscopy. Secondary outcomes were 90-day complications, sexual dysfunction, chordee, or urethrocutaneous (UC) fistula. Cox regression and Fisher’s exact test were used for analysis.

Results: A total of 132 patients were included (mean age 51.3 years; mean stricture length 5.6 cm). Prior endoscopic treatments were performed in 85.6%. Overall, 59.1% were managed with SSU, 21.2% staged BMG, and 19.7% perineal urethrostomy. Median followup was 74 months. Overall stricture-free rate was 82.6%. Clavien ≥2 90-day complications occurred in 8.3%, de novo erectile dysfunction in 4.5%, chordee in 4.5%, and UC fistula in 2.3%. There was no difference in stricture recurrence between techniques (p=0.39), 90-day complications (p=0.43), erectile dysfunction (p=0.93), chordee (p=0.37), and UC fistula (p=0.13). There were no factors associated with stricture recurrence.

Conclusions: Reconstruction of LS PUS yields satisfactory outcomes with no difference between techniques. SSU has similar outcomes compared to staged urethroplasty and has the potential of decreasing the number of surgeries the patient is exposed to.