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Routine Histological Examination of Prepuce in Pathological Phimosis: A Recommended Sustainable Practice.

Rajkiran S Raju1, Ankita Sharma1, Kiran Mahadevappa1

  • 1Pediatric Surgery, St John's Medical College Hospital, Bangalore, IND.

Cureus
|July 25, 2025
PubMed
Summary

Pathological phimosis, often linked to lichen sclerosus, requires circumcision and long-term topical steroids. Routine biopsy of circumcision specimens is recommended for early detection and effective management of this condition in children.

Keywords:
biopsycircumcisionlichen sclerosuspathological phimosistopical steroid

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Area of Science:

  • Pediatric Urology
  • Dermatology
  • Pathology

Background:

  • Phimosis is a common reason for pediatric surgical referral.
  • Pathological phimosis involves chronic inflammation and lichenoid changes, leading to a characteristic preputial plaque.
  • Lichen sclerosus requires circumcision and long-term topical steroid treatment.

Purpose of the Study:

  • To evaluate the histopathological findings in children operated for pathological phimosis.
  • To determine the prevalence of lichen sclerosus and related conditions in this cohort.
  • To assess the effectiveness of current treatment protocols.

Main Methods:

  • Retrospective chart review of 30 children undergoing surgery for pathological phimosis over 32 months.
  • Analysis of demographic data, clinical presentation, and histopathological results.
  • Review of treatment outcomes and follow-up data.

Main Results:

  • The mean age of presentation was 9.6 years.
  • All 25 biopsied specimens showed abnormal findings: lichen sclerosus (72%), lichenoid dermatitis (16%), and chronic inflammation (12%).
  • Four patients with meatal involvement improved with topical steroids.

Conclusions:

  • Recurrence or treatment failure suggests pathological phimosis, necessitating routine biopsy.
  • Lichenoid changes and interface dermatitis are common histopathological findings.
  • Long-term topical steroid therapy and regular follow-up are crucial for managing pathological phimosis.