title: Paediatric preputial pathology: are we circumcising enough?
abstract: BACKGROUND
  Preputial problems are a common reason for referral to the paediatric surgical out-patient department. Many boys referred do not need surgical intervention. One indication for intervention is balanitis xerotica obliterans (BXO), a potentially serious condition previously considered rare in childhood.
  
  
  METHODS
  Consecutive boys referred to a paediatric general surgical out-patient department with problems relating to their prepuce during a period of 4 years were included. The out-patient diagnosis and management was recorded. All foreskins excised were sent for histological analysis.
  
  
  RESULTS
  A total of 422 boys were referred, median age 6 years 2 months (range, 3 months to 16 years). Over half the boys referred simply required re-assurance that all was normal with their penis. However, 186 boys (44.1%) were listed for surgical procedures - 148 circumcision, 33 preputial adhesiolysis, and 5 frenuloplasty. There were histological abnormalities in 110 specimens (84.8%); chronic inflammation (n = 69; 46.6%), BXO (n = 51; 34.5%), and fibrosis (n = 4; 2.7%). Nineteen (12.8%) specimens were reported as histologically normal. The overall prevalence of BXO in the boys referred was 12.1%.
  
  
  CONCLUSIONS
  In this series, the percentage of boys circumcised and the prevalence of BXO were both higher than in other published series. BXO may be more common and present at a younger age than previously thought.
authors.affiliation: Department of Surgery, Derriford Hospital, Plymouth, UK.
authors.forename: I E
authors.initials: IE
authors.lastname: Yardley
authors.forename: C
authors.initials: C
authors.lastname: Cosgrove
authors.forename: A W
authors.initials: AW
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000465:Algorithms; D052798:Balanitis Xerotica Obliterans / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010347:Patient Care Planning; D010409:Penile Diseases / Q000473:pathology* / Q000517:prevention & control; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data