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

Background Phimosis is a frequent indication for pediatric outpatient referral. Pathological phimosis results from chronic inflammatory changes, often with lichenoid changes resulting in a hypopigmented indurated preputial plaque. Treatment of preputial lichen sclerosus is circumcision followed by long-term topical steroid application in histologically confirmed cases. Routine histopathologic examination of circumcision specimens is advisable to detect early cases of lichen sclerosus. Materials and methods A retrospective chart review of children operated for pathological phimosis over a 32-month period was conducted. Demographic details, clinical symptomatology, histological findings, and outcomes at follow-up were collated and analyzed. Results Of the 30 patients enrolled in this study, the mean age of presentation was 9.6 years. Inability to retract the foreskin was seen in all patients, and preputial ballooning were seen in 20 (67%) patients. Biopsy was available in 25 patients, with all specimens demonstrating abnormal findings: lichen sclerosus (18; 72%), lichenoid dermatitis (4; 16%), and chronic non-specific inflammation (3; 12%). Meatal involvement was seen in four patients, with all improved with prolonged topical steroid therapy. Conclusion Recurrence of phimosis or failure despite topical steroid therapy is likely to represent pathological phimosis. Routine biopsy of all pathological phimosis specimens is recommended. Changes in interface dermatitis and lichenoid lymphocytic inflammation are the commonest findings on biopsy, and long-term steroids and regular follow-up are imperative.