title: Histopathological examination of the prepuce after circumcision: Is it a waste of resources?
abstract: BACKGROUND
  The aim of this article is to evaluate the histopathological findings of foreskin after circumcision for medical indications and to find out if analyzing the biopsy is a waste of resources.
  
  
  METHODS
  This retrospective analysis was carried out of the medical records and histopathological findings of 112 boys who underwent circumcision from June 2002 to June 2005. The study group consisted of 52 boys that were circumcised for medical indications, while the control group consisted of 60 boys who underwent circumcision for religious belief.
  
  
  RESULTS
  The mean (range) age of children in the study group was six (2-12) years. 36 boys had phimosis, 15 had recurrent balanoposthitis and one had paraphimosis as an indication for circumcision. Balanitis xerotica obliterans (BXO) was diagnosed in eight out of 52 biopsies (15%). In five of the eight BXO, the histopathological examination revealed focal lichenoid infiltrate which was considered as early form of BXO. There was no suspicion of BXO in the physical examination of those five patients. Chronic inflammation was reported in seven patients, while minor changes in the form of minimal inflammation and oedema were found in another 15 patients. The rest of the biopsies (22 patients) showed normal preputial pathology. The histopathological examinations of the control group revealed chronic inflammation in three patients and acute inflammation with cellular oedema in another three patients.
  
  
  CONCLUSIONS
  There is a place for routine biopsy after circumcision for medical indications. The clinical examination failed to suspect 5 of the 8 cases of BXO that were diagnosed by histopathology.
authors.affiliation: Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-17176 Stockholm, Sweden. hussein.naji@karolinska.se
authors.forename: Hussein
authors.initials: H
authors.lastname: Naji
authors.forename: Esraa
authors.initials: E
authors.lastname: Jawad
authors.forename: Husam A
authors.initials: HA
authors.lastname: Ahmed
authors.forename: Rajaa
authors.initials: R
authors.lastname: Mustafa
mesh_terms: D052798:Balanitis Xerotica Obliterans / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000379:methods*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D052816:Foreskin / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D010688:Phimosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies