Summary
Background
The incidence of preputial lichen sclerosus (PLS) among children presenting with phimosis varies from 10 to 95%, depending on
the age, the protocol for the treatment of pediatric phimosis, the method of diagnosis
(clinical versus histological), and case mix (congenital versus acquired phimosis).
Objective
PLS may not be clinically obvious. Our aim is to show that a systematic histological
examination of the prepuce may diagnose PLS in clinically unsuspected cases.
Methods
Prospective observational study of the histology of all prepuces resected from boys
undergoing circumcision for phimosis but not clinically suspected to have PLS.
Results
PLS was diagnosed histologically in 22 boys (32%). Boys with PLS were significantly
older (mean 8.4 versus 4.7 years old). Diagnosis of PLS was not related to the degree
of phimosis (summary figure). In three patients (grade 4 phimosis) glans discoloration
was observed during surgery, and all had PLS. Follow up for boys found to have PLS
ranged from 1 to 10 years. One patient developed recurrent phimosis, attributed to
inappropriate conservative resection, and required further surgery. There were no
cases of meatal stenosis.
Discussion
Subtle cases of PLS may be difficult to detect clinically. Children are frequently
asymptomatic, except for being unable to retract the prepuce. Physical examination
has a low negative predictive value for the diagnosis of PLS. Complete removal of
the prepuce with permanent glans exposure is regarded as essential to cure PLS and
to avoid recurrent phimosis, but our patients were treated with partial circumcisions
for cultural reasons. Only one needed reoperation for recurrent phimosis.
Conclusion
Graphical AbstractAge tends to be higher in preputial lichen sclerosus) PLS cases, but the degree of
phimosis is not related to the histological diagnosis of the condition.
Keywords
Abbreviations:
PLS (preputial lichen sclerosus), PPV (positive predictive value), NPV (negative predictive value)To read this article in full you will need to make a payment
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References
- Diagnosis and management of male genital lichen sclerosus.Curr Bladdr Dysfunct Rep. 2016; 11: 234-241
- Penile lichen sclerosus (balanitis xerotica obliterans).Br J Urol. 2011; 108: 14-19
- Balanitis xerotica obliterans.Arch Dermatol Syphilol. 1941; 44: 547-561
- Treatment of balanitis xerotica obliterans with hydrocortisone injections.Br J Vener Dis. 1962; 38: 75-77
- Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year follow up after complete circumcision.J Urol. 1994; 152: 987-989
- Balanitis xerotica obliterans: an update for clinicians.Eur J Pediatr. 2020; 179: 9-16https://doi.org/10.1007/s00431-019-03516-3
- Could a careful clinical examination distinguish physiologic phimosis from balanitis xerotica obliterans in children?.Eur J Pediatr. 2021; 180: 591-595https://doi.org/10.1007/s00431-020-03881-4
- Balanitis xerotica obliterans in children and adolescentes: a literature review and clinical series.J Pediatr Urol. 2014; 10: 34-39
- Routine biopsies in pediatric circumcision: (non)sense?.J Pediatr Urol. 2009; 5: 178-180https://doi.org/10.1016/j.jpurol.2008.11.008
- Histopathological examination of the prepuce after circumcision: is it a waste of resources?.Afr J Pediatr Surg. 2013; 10: 164-166https://doi.org/10.4103/0189-6725.115045
- High incidence of balanitis xerotica obliterans in boys with phimosis: a prospective 10-year study.Pediatr Dermatol. 2005; 22: 305-308
- Incidence of balanitis xerotica obliterans in boys younger than 10 years presenting with phimosis.Urol Int. 2013; 90: 439-442
- Troubles with the foreskin: one hundred consecutive referrals to pediatric surgeons.J Roy Soc Med. 2003; 96: 449-451
- Balanitis xerotica obliterans, underdiagnosed pathology of clinical relevance.Cir Pediatr. 2015; 28: 133-136
- Congenital phimosis in patients with and without lichen sclerosus: distinct expression pattern of tissue remodeling associated genes.J Urol. 2013; 189: 268-274https://doi.org/10.1016/j.juro.2012.09.010
- Paediatric preputial pathology: are we circumcising enough?.Ann R Coll Surg Engl. 2007; 89: 62-65
- Lichen sclerosus et atrophicus in children with phimosis and hypospadias.Pediatr Surg Int. 2002; 18: 273-275
- Balanitis xerotica obliterans – a review.World J Urol. 2000; 18: 382-387https://doi.org/10.1007/PL00007083
- Balanitis xerotica obliterans in boys.J Urol. 2005; 174: 1409-1412https://doi.org/10.1097/01.ju.0000173126.630194.b3
- Treatment of balanitis xerotica obliterans in pediatric patients.Cir Pediatr. 2020; 33: 79-83
- Meatal stenosis in boys following circumcision for lichen sclerosus (balanitis xerotica obliterans).J Urol. 2014; 192: 1784-1788
Article info
Publication history
Published online: July 06, 2022
Accepted:
June 30,
2022
Received in revised form:
June 16,
2022
Received:
January 20,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
