Editing CUA: Circumcision (2018) (section)

== Medical indications for childhood circumcision ==

# '''Pathologic phimosis'''
#* Alternative treatments, such as preputioplasty, dorsal slit, or '''steroid therapy, can be attempted,''' but depending on the severity of the scar tissue circumcision may be the only curative option when true phimosis is diagnosed.
# '''Genital lichen sclerosis (LS)'''
#* See Lichen Sclerosis section in Penis and Urethra Surgery Chapter Notes
#* Also known as balanitis xerotica obliterans
#* A chronic, inflammatory dermatosis of the prepuce and glans penis, which can potentially involve the meatus and urethra.
#** Overall, the incidence of meatal involvement leading to stenosis is low (2%).
#* Etiology is unknown and probably multifactorial, with a possible autoimmune or infective etiology.
#* Should be suspected when clinical examination reveals a more impressive (than phimosis) thick white ring-like cicatrix at the distal preputial ring, associated with white discoloration and plaque formation.
#* '''Management'''
#** '''The use of topical steroids in LS is debatable, with low response rates. It also requires close follow-up, as disease progression may lead to glans and urethral involvement.'''
#** '''Circumcision is usually curative''', but some children, depending on the degree of involvement, may need a meatoplasty, glans resurfacing, or urethral reconstruction.
#** '''A trial of steroids may alleviate the need for surgery in selected cases, although if phimosis is an issue then a circumcision is generally required'''§
# '''An adjunct or alternative to prophylactic antibiotics in infants with UTI-predisposing urological abnormalities, as described above.'''