OBJECTIVE: At our institute we usually send the foreskin after circumcision for pathological examination. Does this make sense or is it merely medical overconsumption? MATERIAL AND METHODS: A retrospective analysis was carried out of all pediatric patients who underwent a circumcision, from August 2005 to January 2008, for persisting pathological phimosis after treatment with topical steroids. Religious circumcisions were excluded. RESULTS: Balanitis xerotica obliterans (BXO) was diagnosed in 37 out of 135 biopsies (27%). In 19 of the 37 boys with pathological evidence of BXO (51%), the physical examination matched the pathology. Meatal stenosis was found in six cases; four were also diagnosed with BXO. CONCLUSIONS: In this study, 27% of all biopsies were positive for BXO. The results show that the diagnosis BXO must be based on biopsy, because clinical findings underestimated the incidence of BXO by almost 50%. BXO implies a higher incidence of meatal stenosis, urethral pathology and has a known association with penile carcinoma. We conclude that there is a place for routine biopsy of the foreskin after circumcision for pathological phimosis, taking into account the potential clinical consequences when BXO is diagnosed.
OBJECTIVE: At our institute we usually send the foreskin after circumcision for pathological examination. Does this make sense or is it merely medical overconsumption? MATERIAL AND METHODS: A retrospective analysis was carried out of all pediatric patients who underwent a circumcision, from August 2005 to January 2008, for persisting pathological phimosis after treatment with topical steroids. Religious circumcisions were excluded. RESULTS:Balanitis xerotica obliterans (BXO) was diagnosed in 37 out of 135 biopsies (27%). In 19 of the 37 boys with pathological evidence of BXO (51%), the physical examination matched the pathology. Meatal stenosis was found in six cases; four were also diagnosed with BXO. CONCLUSIONS: In this study, 27% of all biopsies were positive for BXO. The results show that the diagnosis BXO must be based on biopsy, because clinical findings underestimated the incidence of BXO by almost 50%. BXO implies a higher incidence of meatal stenosis, urethral pathology and has a known association with penile carcinoma. We conclude that there is a place for routine biopsy of the foreskin after circumcision for pathological phimosis, taking into account the potential clinical consequences when BXO is diagnosed.