Surgical management of genitourinary lichen sclerosus et atrophicus in boys in England: A 10-year review of practices and outcomes

Summary Introduction Circumcision has long been the mainstay of management for genitourinary lichen sclerosus et atrophicus (LS); however, there has been growing interest in surgical techniques that preserve the foreskin. Objective The aim of this study was to assess population-based surgical management of LS in England and determine surgical outcomes. Study design Cases of LS treated in English NHS trusts (2002–2011) were extracted from the Hospital Episode Statistics (HES) Database. Cases were identified by both an ICD-10 code for LS and either an OPCS4.6 code for circumcision or preputioplasty (with/without injection of steroid). Subsequent admissions were analysed for related complications/procedures. Data are presented as median (interquartile range) unless otherwise stated. Results 7893 patients had surgery for LS, of whom 7567 (95.8%) underwent circumcision ( Table ). Primary preputioplasty was performed in 326 (4.1%) in 44/130 centres; of these 151/326 had concomitant injection of steroid. Age at surgical intervention was 9 (6–11) years. There were no postoperative bleeds following preputioplasty. Of those treated with preputioplasty, 74 (22%) had subsequent circumcision at a median of 677 (277–1203) days post operation. Concomitant steroid injection reduced the risk of subsequent circumcision (21/151 (14%) vs. 53/175 (30%), p Conclusion Although circumcision is the predominant treatment for LS, these data suggest that preputioplasty is a valid option in management, albeit with a higher re-intervention rate. Selection bias may play a role and a randomized controlled trial is needed. Preputioplasty combined with steroid injection appears to reduce the chance of completion circumcision. Table . Comparison between circumcisions and preputioplasties. Age at primary operation Day-case procedures Infection Postoperative bleeding Further meatal intervention Further urethral intervention Circumcisions (N = 7567) 9 (6–11) 6960 (92%) 48 (0.6%) 61 (0.8%) 421 (5.6%) 129 (1.7%) Preputioplasties (N = 326) 9 (7–11) 303 (92.9%) 1 (0.3%) 0 10 (3.1%) 8 (2.5%) p-value 0.292 0.528a 0.723b 0.182b 0.051a 0.205a Continuous variable displayed using median (IQR) and compared using Mann–Whitney U Test. Categorical variables portrayed as n (%) and compared using chi-squarea and Fisher's Exact test.b Note subgroup analysis presented in the main text.