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

Purpose: Of boys circumcised for penile lichen sclerosus, ie balanitis xerotica obliterans, 7% to 19% require late surgery for meatal stenosis. We review the management and outcomes of boys circumcised for lichen sclerosus. Materials and Methods: Medical records of boys with clinical lichen sclerosus were reviewed for the period 2000 to 2010. Patients were excluded from the study if the foreskin was not submitted for histopathological analysis, circumcision was not performed at the center during the study period or medical records were unavailable. Data were compared by Fisher exact test and univariate analysis. Results: Of 300 circumcised boys lichen sclerosus was confirmed in 250. A total of 50 patients had nonlichen sclerosus histology. Mean age was 9.0 years (range 4 to 16) in patients with lichen sclerosus and 8.3 years (2 to 15) in those with nonlichen sclerosus histology. Boys with lichen sclerosus were more likely to have the meatus described as abnormal (57 vs 4) and to have undergone a meatal procedure at circumcision (55 vs 2) or a meatal operation at a later date (49 vs 3, all p < 0.05). Boys with lichen sclerosus requiring later meatal procedures (meatal dilation in 25, meatotomy in 24) rarely underwent a meatal procedure at circumcision (4 of 49) and were less likely to have received preoperative topical steroids than boys not needing a later meatal procedure (2 of 49 vs 49 of 151, p < 0.05). Conclusions: 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.