Frequency of lichen sclerosus in children presenting with phimosis: A systematic histological study
Antonio Merched Aziz Filho1, Lucia Maria Soares de Azevedo2, Mayra Carrijo Rochael2
1Getúlio Vargas Filho Children´s Hospital, Niterói, Rio de Janeiro, Brazil.
Insights
Preputial lichen sclerosus (PLS) is often missed in boys with phimosis. Histological examination of resected foreskins can diagnose PLS in unsuspected cases, with many patients benefiting from partial circumcision.
Area of Science:
- Pediatric Urology
- Dermatology
- Pathology
Background:
- Preputial lichen sclerosus (PLS) incidence in pediatric phimosis cases ranges widely (10-95%).
- Clinical diagnosis of PLS can be challenging, especially in children.
- Variability in diagnosis depends on age, treatment protocols, and diagnostic methods (clinical vs. histological).
Purpose of the Study:
- To evaluate the utility of systematic histological examination for diagnosing PLS in children with phimosis.
- To identify clinically unsuspected cases of PLS through histological analysis.
Main Methods:
- Prospective observational study.
- Histological examination of all resected prepuces from boys undergoing circumcision for phimosis.
- Inclusion criteria: boys with phimosis, without clinical suspicion of PLS.
Main Results:
- Histological PLS was diagnosed in 32% of boys (22/69).
- Boys with PLS were significantly older (mean 8.4 years) than those without (mean 4.7 years).
- Glans discoloration was observed in 3 patients with grade 4 phimosis, all of whom had PLS.
Conclusions:
- Approximately one-third of boys with phimosis have histological PLS, often without typical clinical signs.
- Systematic histological examination is crucial for detecting subtle PLS cases.
- Partial circumcision may be effective for treating PLS in these patients, potentially avoiding recurrence.
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:
Histological PLS was present in approximately 1/3 of boys with phimosis, frequently without typical manifestations. Those patients may be cured with partial circumcisions.
More Related Videos
06:15Author Spotlight: Anterior HR-OCT as a Non-Invasive Tool for Characterizing Ocular Surface Squamous Neoplasia
Published on: August 9, 2024
09:32Resolving Water, Proteins, and Lipids from In Vivo Confocal Raman Spectra of Stratum Corneum through a Chemometric Approach
Published on: September 26, 2019