The reviewers focused in on several of the key points of our manuscript. The goal in treating this complex subset of patients is to restore unobstructed physiologic voiding and improve quality of life. Patients should be openly counseled that high success rates and significant improvements in quality of life can be achieved, but they should also understand that up to one quarter will require revision of either their first or second stage procedure. This is of the greatest importance to emphasize to patients presenting with long (>10 cm), extensive, lichen sclerosus strictures, because they experienced a greater revision rate than the patients without lichen sclerosus-related stricture and experienced most of our ultimate treatment failures. Some patients will choose to stop after the first procedure, because they have already achieved unobstructed voiding and experienced a significant improvement in their quality of life, while avoiding the future risk of another surgery.
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