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

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.