Introduction <p>Lichen sclerosus et atrophicus (LS), often known as Balanitis Xerotica Obliterans, is a common indication for paediatric circumcision. LS is associated with scarring of the foreskin and glans, with meatal stenosis a possible complication. This study aimed to assess the incidence of meatal stenosis among patients undergoing circumcision for LS and assess the risk factors and management of meatal stenosis.</p> Methods <p>A retrospective case note review was undertaken of all patients under the age of 16 in NHS Grampian undergoing circumcision for LS from 2017 to 2022. Demographics, intervention and outcome data was collected.</p> Results <p>131 male patients, with a median age of 9-years-old, underwent circumcision for LS over a 5-year period. Histology was sent for 122 patients of which 117(95.9%) was positive for LS. 15/117 (12.8%) patients were diagnosed clinically with meatal stenosis post-operatively. 9/117(7.7%) patients underwent uroflow studies. 4 patients were managed conservatively after normal uroflows. 11 patients (9.4%) required surgical intervention. 5 patients underwent meatal dilatation. However, 2 patients required further meatoplasty after initial dilatation. 6 patients underwent primary meatoplasty. 42(35.9%) patients were prescribed topical steroids pre-operatively and 21(17.9%) post-operatively. Fischer’s exact test and a Pearson Chi square indicated a significant link between post-operative steroid use and meatal stenosis. However, this is likely due to prescribers favouring steroid use in patients with significant LS of the glans associated with meatal stenosis.</p> Conclusion <p>Meatal stenosis following circumcision for LS is a common finding with an incidence of 12.8% in our study. 73.3% (11/15) of these patients required further surgical management with meatal dilatation and/or meatoplasty. Meatal dilatation was successful in 3/5 patients. Meatoplasty was successful in 6/6 patients. Steroid use was hard to assess due to large variation amongst prescribers. Formulation of a guideline for steroid use in LS patients would help provide consistent care to patients. Further controlled studies would be required to confirm whether peri-operative steroid use is useful for prevention of meatal stenosis following LS.</p>