Routine biopsies in pediatric circumcision: (Non) sense?

Abstract

At our institute we usually send the foreskin after circumcision for pathological examination. Does this make sense or is it merely medical overconsumption? 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. 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. 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.