Paediatric preputial pathology: are we circumcising enough?

Ann R Coll Surg Engl. 2007 Jan;89(1):62-5. doi: 10.1308/003588407X160828.


Introduction: 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.

Patients and 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.

MeSH terms

  • Adolescent
  • Algorithms
  • Balanitis Xerotica Obliterans / surgery
  • Child
  • Child, Preschool
  • Circumcision, Male / statistics & numerical data*
  • Humans
  • Infant
  • Male
  • Patient Care Planning
  • Penile Diseases / pathology*
  • Penile Diseases / prevention & control
  • Referral and Consultation / statistics & numerical data
  • Workload / statistics & numerical data