The Surgical Management of Lichen Sclerosus of the Glans Penis: Our Experience and Review of the Literature Giulio Garaffa, MD, FRCS, Majid Shabbir, FRCS, Nim Christopher, FRCS, Suks Minhas, MD, FRCS, and David J. Ralph, FRCS St Peter’s Andrology, University College London Hospitals—Urology, London, UK DOI: 10.1111/j.1743-6109.2010.02165.x ABSTRACT Introduction. Lichen sclerosus (LS) of the glans penis is a chronic, progressive, scleroatrophic inflammatory process of unknown etiology affecting the glans penis, prepuce, and urethra and may lead to severe impairment of sexual and urinary function. Aims. To report our experience of surgical management of LS of the glans penis. Main Outcome Measures. Complications, patients’ satisfaction, cosmesis, resolution of pain and puritus, and postoperative sexual function and were recorded retrospectively. Methods. The surgical outcome of the 31 patients who have undergone resurfacing of the glans penis with the use of skin grafting for the management of genital LS in our institute is reported. Results. After a median follow-up of 12.8 months, 26 patients (84%) were fully satisfied with cosmetic and functional results, and 71% of them have resumed sexual activity. Conclusions. Resurfacing of the glans penis represents a simple and reproducible technique for the management of LS and yields excellent functional and cosmetic results. Garaffa G, Shabbir M, Christopher N, Minhas S, and Ralph DJ. The surgical management of Lichen Sclerosus of the glans penis: Our experience and review of the literature. J Sex Med 2011;8:1246–1253. Key Words. Lichen Sclerosus; Penile Cancer; Phimosis; Glans Resurfacing; Balanitis Xerotica Obliterans; Scle- roatrophic Inflammatory Process of the Penis Introduction L ichen sclerosus (LS), previously known as balanitis xerotica obliterans, was initially described in 1928 as a chronic, progressive, scle- roatrophic inflammatory process of unknown eti- ology affecting the glans penis, prepuce, and urethra either individually or in any combination [1,2]. Lichen sclerosus most often occurs in the 4th and 5th decade of life, but has also been described in adolescents and in extremes of age. In uncir- cumcised patients, preputial involvement usually presents as a sclerotic constricting band, which may progress to phimosis. Changes on the glans may be discreet or diffuse, and may range from mottled patches to globally thickened and discol- ored skin. In the advanced stages, balanopreputial adhesions can lead to partial or complete oblitera- tion of the coronal margin and preputial space. Glanular involvement may also extend to involve the urethral meatus and fossa navicularis causing meatal stenosis. Although rare, more proximal urethral involvement has also been described [2–6]. Symptomatically, phimotic patients typically present with difficulty retracting the foreskin, leading to painful splitting and bleeding, especially during intercourse. Patients with disease affecting the glans can develop marked sexual dysfunction in addition to the poor cosmesis. Patients with meatal or urethral involvement develop symptoms ranging from simple spraying to marked obstruc- tive and irritative urinary symptoms. The exact etiology of LS remains unclear; theo- ries have hypothesized a possible autoimmune 1246 J Sex Med 2011;8:1246–1253 © 2011 International Society for Sexual Medicine