Lichen sclerosus et atrophicus in children with phimosis and hypospadias

Abstract

This prospective study was designed to evaluate the incidence of lichen sclerosus et atrophicus (LSA) in a pediatric population with hypospadias and phimosis in order to discuss the indications for circumcision and utilization of preputial skin for urethral surgery. All 115 boys, 55 with congenital phimosis, 45 with acquired phimosis, 13 with hypospadias, and 2 with recurrent chronic balanitis, underwent full-thickness biopsies of the foreskin that were examined by a single pathologist. Of the patients with acquired phimosis, 88% showed inflammatory features in the foreskin; 60% had LSA. Of the patients with congenital phimosis, 82% showed inflammatory disease in the prepuce; 30% had LSA. Of the patients operated upon for hypospadias, 61% showed histologic findings of chronic inflammation of the foreskin and LSA was evident in 15%. The high incidence of LSA in the prepuce of patients with phimosis suggests that circumcision should be performed to correct this disease. The frequent presence of chronic inflammation is a possible cause of stenosis when the foreskin is used to perform a urethroplasty in patients with hypospadias.

Failed hypospadias in paediatric patients

“…96 BXO is thought to account for 4-15% of the strictures that occur after hypospadias repairs in which the urethroplasty is performed using a prepucial flap or graft. 97,98 Substitution urethroplasty with oral mucosa is mandatory in the presence of BXO. 98,99 Urethral diverticula Dilation of the neourethra (Figure 4), also known as megalourethra, has been described after the correction of proximal hypospadias, 100,101 although only for flap tube repairs.…”

Penile inflammatory skin disorders and the preventive role of circumcision

“…[95] A further study found LS in 60% of boys with acquired phimosis and in 30% of those with congenital phimosis. [96] Foreskin inflammation was seen in 88% and 82%, respectively. The study also examined boys with congenital hypospadias, with 61% showing symptoms of inflammation and 15% having features consistent with LS.…”

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…Meatal or urethral involvement is more likely with a history of previous surgery and was seen in 27% in the series by Gargollo et al [168]. The incidence of this condition is underestimated and recent evidence suggests that in boys referred with a diagnosis of phimosis the incidence ranges between 10-40 % [169][170][171][172]. In a series of 100 boys referred for phimosis, the incidence of LS was 1.8% under 6 years of age and up to 21% in those older [171].…”