Time to rethink routine histopathology after adult circumcision? Long-term oncological outcomes from an 11-year cohort

PURPOSE: To evaluate whether routine histopathological examination of the prepuce following adult circumcision without clinical suspicion of malignancy influences patient management and healthcare resource utilisation, and to report circumcision frequency and long-term oncological outcomes. METHODS: A retrospective cohort study was conducted of all adult circumcisions performed between January 2015 and December 2025. Patients aged ≥ 15 years undergoing circumcision for symptomatic phimosis, paraphimosis, or recurrent balanitis were included. Cases with suspected malignancy or known premalignant lesions were excluded. Demographic, operative, histopathological, and follow-up data were extracted from electronic records. Median follow-up was 85 months. Cost analysis was based on an estimated histopathology cost of £226 per specimen. RESULTS: Of 1,648 listed patients, 1,523 met the inclusion criteria (median age 44 years). Phimosis was the primary indication (98.2%). Lichen sclerosus was identified in 62% of specimens, while incidental penile intraepithelial neoplasia (PeIN) was detected in 0.5%. No invasive carcinomas were identified. All PeIN cases were managed with circumcision alone, and no progression or additional intervention was required at a median follow-up of 81 months. Eliminating routine histopathology would have saved 304.6 consultant hours and £344,198 over 11 years (£31,291 annually). CONCLUSIONS: In the absence of clinical suspicion, routine histopathological examination of the prepuce rarely detects clinically significant malignancy or alters management. A selective, risk-adapted approach may optimise resource utilisation while maintaining oncological safety.