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.

Complications Of Peri-Operative Ureteral Catheter Placement: Experience at A Major Cancer Center.

OBJECTIVE: To evaluate risks of peri-operative ureteral catheter placement in a consecutive patient-series. METHODS: Patients who underwent peri-operative ureteral catheter placement at a single institution in 2018 were included. A retrospective review was conducted to evaluate patient and procedure related characteristics, including data on technique, perceived placement difficulty, operative details, and complications. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Urologic complications within 30 days were evaluated using the Clavien-Dindo system. Statistical analysis for association was conducted using the X2 test or fisher's exact tests. RESULTS: 413 patients were included. 50/413 (12.1%) cases had urologic complications within 30 days. 43 were Clavien-Dindo grade I-II. Six were grade III. 5/6 patients had oliguric, obstructive AKI. One had flank pain with hydronephrosis. Two patients each underwent placement of unilateral nephrostomy tube, bilateral double-J stent placement, and unilateral stent placement. One patient had a Grade V complication. They developed multi-system organ failure including renal failure with hydronephrosis.All patients who required re-intervention had bilateral peri-operative catheterization with use of a wire. Intraoperative difficulty with placement was associated with high-grade complication (P<.01)). Limitations include retrospective,single center study design. CONCLUSIONS: Rate of acute complication following ureteral catheter placement is 12%. 1.7% of patients develop post-operative ureteral obstruction requiring intervention within 30 days. Future studies are needed to determine patients most at risk for post-ureteral stent complication.