Meatal Stenosis in Boys following Circumcision for Lichen Sclerosus (Balanitis Xerotica Obliterans)

Abstract

After circumcision for lichen sclerosus up to 1 in 5 boys requires a subsequent operation for meatal pathology. Pre-circumcision topical steroids may help decrease the rate of later meatal pathology. Submission of the foreskin for histological analysis should always be considered, as prognosis differs for lichen sclerosus vs nonlichen sclerosus histology. We recommend a care pathway for boys with lichen sclerosus.

Foreskin Morbidity in Uncircumcised Males

“…The true percentage of boys with BXO who develop meatus stenosis is most likely even higher in our study due to insufficient histologic examination. The percentage of boys requiring treatment of meatus stenosis among boys with histologically verified BXO is comparable to Homer et al, 16 who found that 20% of boys with BXO require operation for meatal pathology during circumcision and a further 20% require a later meatal procedure.…”

Circumcision in the paediatric patient: A review of indications, technique and complications

“…For patients with more extensive disease that may involve the urethral meatus and distal urethra, it may be necessary to consider meatoplasty, urethrotomy, urethral dilatation or even urethroplasty . Up to 20% of boys who undergo circumcision for BXO may need a subsequent operation for ongoing pathology . The presence of a white plaque on the glans once the prepuce is retracted signifies involvement with BXO.…”

Penile inflammatory skin disorders and the preventive role of circumcision

“…A study in Liverpool, UK, of 300 boys (mean age 9 years; range 4–16 years) circumcised after clinical diagnosis of LS, confirmed LS by histology in 80% and 1 in 5 required subsequent meatal dilatation or meatotomy for meatal pathology. [108]…”