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Comparative Study
. 2026 Feb;61(2):162656.
doi: 10.1016/j.jpedsurg.2025.162656. Epub 2025 Sep 12.

Perspectives of boys, families & surgeons: Preputioplasty vs. circumcision for treatment of lichen sclerosus

Jennifer A Kirton  1 , Harriet J Corbett  2 , Bridget Young  3 , Andrew Kirkcaldy  4 , Simon Kenny  5 , Mary G Cherry  6
Affiliations
Comparative Study

Perspectives of boys, families & surgeons: Preputioplasty vs. circumcision for treatment of lichen sclerosus

Jennifer A Kirton et al. J Pediatr Surg. 2026 Feb.

Abstract

Objectives: i) to explore experiences of boys and parents/guardians regarding surgical treatment options for lichen sclerosus et atrophicus (LS/BXO); ii) to gather surgeons' perspectives to inform design of a randomized controlled trial (RCT) comparing preputioplasty with intralesional steroids (PIT) versus circumcision to treat LS.

Patients and methods: Semi-structured qualitative interviews conducted with 20 boys (aged 8-18 years) and their families who had previously undergone PIT (n = 15) or circumcision (n = 6). Focus groups/interviews were held with 17 surgeons. Participants were recruited from a regional children's hospital and professional networks. Data were analysed thematically.

Results: Patients and families commonly misunderstood foreskin function and surgical options. Delayed symptom recognition and limited awareness of PIT were frequent. Families weighed up immediate versus long-term outcomes when making treatment decisions: some chose circumcision, perceiving it as a definitive resolution, others preferred PIT for foreskin preservation. Boys opted for PIT due to aesthetic concerns, families were concerned about long-term impacts of circumcision. Surgeons supported offering PIT but emphasised the need for RCTs to confirm its effectiveness. Satisfaction was high in both patient groups. Boys, families, and surgeons identified factors they considered important outcomes, which they believed should be measured in future evaluations of both treatments.

Conclusion: This study highlights the importance of offering the option to retain the foreskin during surgical treatment for LS. It emphasises the need for clinicians to understand patient preferences and calls for better education on normal foreskin anatomy and surgical options, as well as further research into PIT through a RCT.

Keywords: Balanitis xerotica obliterans; Circumcision; Interviews; Lichen sclerosus; Phimosis; Preputioplasty; Qualitative.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:The research was funded by The Children's Research Fund, Charity number: 226128. Dr Jennifer Kirton's salary came from this funding, as will the publication charges if the article is accepted. The form does not allow me to select this option in the ‘reported work’ section since this charity is not named in the drop down list. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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