Lichen Sclerosus and Human Papillomavirus in Failed Hypospadias Repair: A Histopathological Case Series

BACKGROUND: Lichen sclerosus (LS) is a chronic inflammatory dermatosis that can affect the male genitalia and has been implicated in urethral and meatal complications. Its role in hypospadias surgery outcomes remains controversial. Additionally, a possible association between LS and human papillomavirus (HPV) infection has been suggested. This study aimed to evaluate the presence of LS, koilocytic changes, and HPV in tissue samples obtained during hypospadias surgery and to assess their relationship with postoperative complications. METHODS: A retrospective case series was conducted, including 11 pediatric patients who underwent hypospadias repair between 2015 and 2020 and had intraoperative biopsies demonstrating LS. A total of 13 tissue specimens were analyzed using histopathology and polymerase chain reaction (PCR) for HPV detection and genotyping. Postoperative outcomes were reviewed and correlated with the histopathological findings. RESULTS: The overall complication rate was 54.5% (6/11). LS was identified in all specimens. Koilocytic changes were observed in 76.9% of samples, and HPV DNA was detected in 46.1%, including serotypes 6, 16, 18, and 33. No significant association was found between the presence of HPV or koilocytic changes and postoperative complications (p>0.05). CONCLUSIONS: LS was consistently identified in tissue samples obtained during hypospadias repair in this small series and may represent an underlying pathological factor in some patients. Although HPV was detected in a subset of cases, its clinical significance remains uncertain, as no association with postoperative complications was demonstrated. These findings should be interpreted with caution given the limited sample size. Further studies are needed to clarify the role of HPV and the impact of LS on reconstructive outcomes in hypospadias surgery.