The buccal belt: a buccal mucosal graft sub-coronal resurfacing for recurrent penile adhesions in patients with lichen sclerosus.

BACKGROUND: Penile adhesions may cause pain, bleeding, disfigurement and distress. In the setting of lichen sclerosus (LS), they often recur but current treatment options are limited. We present a novel surgical technique for treatment of recurrent penile adhesions using sub-coronal buccal mucosal graft (BMG) resurfacing. METHODS: A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. Patients with > 12-month follow-up were included in analysis. The procedure involved circumferential excision of the diseased skin and replacement with a BMG. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcome measures (PROMs) including Sexual Health Inventory for Men (SHIM) questionnaire and Global Response Assessment (GRA) questionnaire measuring functional and esthetic outcomes. RESULTS: Twenty-five men underwent the procedure across six institutions between 3/2014 and 11/2019. Twenty-one men met inclusion criteria. Mean operative time and hospital stay for sub-coronal resurfacing were 40 min (25-50) and 0.76 days (1-2), respectively. At the mean follow-up of 18 months (12-61), no patients developed recurrence. All patients who presented with pain and postcoital bleeding saw improvement on follow-up (18/18). There was a significant improvement in SHIM scores after the operation (14.4 pre-op, 17.0 post-op; p = 0.003). Overall improvement of symptoms was reported by all patients: 57% GRA + 3; 29% GRA + 2; 14% GRA + 1. Baseline penile sensation was preserved in 17/21 (81%) patients. CONCLUSIONS: Recurrent penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction.