Histopathological examination of the prepuce after circumcision: Is it a waste of resources?

Abstract

Background: The aim of this article is to evaluate the histopathological fi ndings of foreskin after circumcision for medical indications and to fi nd out if analyzing the biopsy is a waste of resources.

Material and Methods: This retrospective analysis was carried out of the medical records and histopathological fi ndings of 112 boys who underwent circumcision from June 2002 to June 2005. The study group consisted of 52 boys that were circumcised for medical indications, while the control  group consisted of 60 boys who underwent circumcision for religious belief.

Results: The mean (range) age of children in the study group was six  (2-12) years. 36 boys had phimosis, 15 had recurrent balanoposthitis and  one had paraphimosis as an indication for circumcision. Balanitis xerotica obliterans (BXO) was diagnosed in eight out of 52 biopsies (15%). In five of the eight BXO, the histopathological examination revealed focal lichenoid infi ltrate which was considered as early form of BXO. There was  no suspicion of BXO in the physical examination of those fi ve patients. Chronic infl ammation was reported in seven patients, while minor changes in the form of minimal infl ammation and oedema were found in another 15 patients. The rest of the biopsies (22 patients) showed normal  preputial pathology. The histopathological examinations of the control group revealed chronic infl ammation in three patients and acute infl ammation with cellular oedema in another three patients.

Conclusions: There is a place for routine biopsy after circumcision for  medical indications. The clinical examination failed to suspect 5 of the 8 cases of BXO that were diagnosed by histopathology.

Keywords: Balanitis xerotica obliterans, circumcision, pathology, phimosis