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Lichen sclerosus et atrophicus in children with phimosis and hypospadias
G Mattioli1, P Repetto, C Carlini
1Department of Pediatric Surgery, Giannina Gaslini and Clinical Institute, Largo G. Gaslini 5, 16100 Genova, Italy.
Insights
Lichen sclerosus et atrophicus (LSA) is common in boys with phimosis and hypospadias. This suggests circumcision may be indicated for LSA and highlights risks of using affected foreskin for hypospadias surgery.
Area of Science:
- Pediatric Urology
- Dermatopathology
- Surgical Pathology
Background:
- Phimosis and hypospadias are common pediatric urogenital conditions.
- Preputial skin is sometimes utilized for reconstructive surgery in hypospadias.
- Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin condition.
Purpose of the Study:
- To determine the incidence of LSA in pediatric patients with phimosis and hypospadias.
- To evaluate the implications of LSA and inflammation for circumcision and urethroplasty.
Main Methods:
- Prospective study of 115 boys undergoing foreskin biopsy.
- Histopathological examination by a single pathologist.
- Patient groups included congenital phimosis, acquired phimosis, hypospadias, and balanitis.
Main Results:
- LSA was diagnosed in 60% of acquired phimosis cases and 30% of congenital phimosis cases.
- 15% of hypospadias patients showed LSA, with 61% exhibiting chronic inflammation.
- Significant inflammatory changes were noted in most phimosis cases.
Conclusions:
- High LSA incidence in phimosis supports circumcision for its treatment.
- Chronic inflammation in preputial tissue may complicate its use in hypospadias repair.
- Histological evaluation is crucial for managing these pediatric conditions.
Abstract:
This prospective study was designed to evaluate the incidence of lichen sclerosus et atrophicus (LSA) in a pediatric population with hypospadias and phimosis in order to discuss the indications for circumcision and utilization of preputial skin for urethral surgery. All 115 boys, 55 with congenital phimosis, 45 with acquired phimosis, 13 with hypospadias, and 2 with recurrent chronic balanitis, underwent full-thickness biopsies of the foreskin that were examined by a single pathologist. Of the patients with acquired phimosis, 88% showed inflammatory features in the foreskin; 60% had LSA. Of the patients with congenital phimosis, 82% showed inflammatory disease in the prepuce; 30% had LSA. Of the patients operated upon for hypospadias, 61% showed histologic findings of chronic inflammation of the foreskin and LSA was evident in 15%. The high incidence of LSA in the prepuce of patients with phimosis suggests that circumcision should be performed to correct this disease. The frequent presence of chronic inflammation is a possible cause of stenosis when the foreskin is used to perform a urethroplasty in patients with hypospadias.
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