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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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.
