Does routine histology alter management post circumcision?

Kerr, Lynne M.; Hendry, Jane; Crookshanks, Aaron; Taylor, Jennifer

doi:10.1177/2051415819895399

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…It is common practice (at least in large parts of the UK) for circumcision samples not to be processed histologically in their entirety. 16,17 Instead, only random or 'representative' samples of the prepuce are examined. This raises problems due to the focal nature of MGLSc and areas of incipient or burnt-out disease.…”

Section: Discussionmentioning

confidence: 99%

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Male genital lichen sclerosus, microincontinence and occlusion: mapping the disease across the prepuce

Kravvas

Muneer

Watchorn

et al. 2022

Clinical and Experimental Dermatology

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Summary Background Male genital lichen sclerosus (MGLSc) can lead to significant sexual dysfunction and urological morbidity, and is also a risk factor for premalignant disease (penile intraepithelial neoplasia and penile cancer), particularly squamous cell carcinoma. Although the precise aetiopathogenesis of MGLSc remains controversial, accumulated evidence indicates that it is related to chronic, intermittent, occluded exposure to urine. Aim To perform spatial mapping of MGLSc across the human prepuce and assess how this supports the urinary occlusion hypothesis. Methods Preputial samples were collected from 10 patients with clinically diagnosed MGLSc undergoing circumcision. The samples were then divided into a grid pattern and 10 punch biopsies were obtained from each section to determine the extent and distribution of the disease process across each prepuce. Results All 10 patients reported having urinary microincontinence, and all were histologically confirmed as having MGLSc. The most proximal aspect of the prepuce was found to be universally affected by MGLSc in all patients, whereas the most distal part was overwhelmingly shown to be the least affected area. Of the 63 MGLSc‐affected regions, 62 were in direct physical contiguity with one another. The histological extent of the disease was not found to be congruent with either the severity of the symptoms reported by the patients or the clinical examination. Conclusion In uncircumcised men with urinary microincontinence, after the prepuce has been replaced post micturition, small amounts of urine can pool between the juxtaposed epithelial surfaces. The proximal aspect of the prepuce is subjected to the maximum amount of occlusion and maximal contact with accumulated urine, whereas the distal prepuce is subjected to the least. Our findings suggest that accentuated contact between urine and susceptible penile epithelium due to occlusion can lead to MGLSc. Furthermore, contiguity data suggest that once established, it is possible that MGLSc advances across tissues by physical contact. This is the first study examining the changes in the preputial landscape in patients with LSc and contributes to our understanding of disease aetiology and progression.

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Section: Discussionmentioning

confidence: 99%

“…Finally, it is not uncommon for clinically confirmed MGLSc to be missed histologically even in circumcision samples. It is common practice (at least in large parts of the UK) for circumcision samples not to be processed histologically in their entirety 16,17 . Instead, only random or ‘representative’ samples of the prepuce are examined.…”

Section: Discussionmentioning

confidence: 99%

Male genital lichen sclerosus, microincontinence and occlusion: mapping the disease across the prepuce

Kravvas

Muneer

Watchorn

et al. 2022

Clinical and Experimental Dermatology

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“…Most recently, Kerr et al. [ 11 ] report that clinical diagnosis of lesions in the prepuce correspond to histological diagnosis in up to 80% of cases. Coupled with the lack of evidence associating dermatological lesions of the foreskin with the development of Squamous Cell Carcinoma, these authors are of the opinion that routine histology testing is not required and that clinicians can reliably achieve a diagnosis solely with a physical examination of the area.…”

Section: Discussionmentioning

confidence: 99%

Primary syphilis chancre masquerading as a frenulum tear, the essence of histology: a case report

Tan

Walford²,

Tan³

2022

Oxford Medical Case Reports

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Syphilitic chancres are pathognomonic of primary syphilis and can have many atypical presentations. Early detection of such lesions can prevent complications by linking patients to care early. We report a case of a 45-year-old Chinese men who has sex with men (MSM) presenting with a wound on his penis after masturbation. Initial impressions of a frenulum tear secondary to overzealous masturbation led to a circumcision and frenulectomy. Routine histology done provided an unexpected finding of plasma cell infiltrates suggestive of Syphilis. Serology was done to confirm the diagnosis and patient was treated with oral doxycycline for 2 weeks. This case aims to highlight the importance of routine histology during circumcisions especially because lesions such as syphilitic chancres are not always typical in presentation.

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“…We write to express our reservations about the article ‘Does routine histology alter management post-circumcision?’ by Kerr et al 1 , recently published in the Journal of Clinical Urology . The stated aims were ‘to confirm that routine histology for circumcision is not required and that clinical diagnosis is largely accurate.…”

mentioning

confidence: 98%