Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden.
BJU Int. 2021 Apr;127(4):428-434. doi: 10.1111/bju.15221. Epub 2020 Sep 21.
To investigate the prevalence of pathological disease and spectrum of human papillomavirus (HPV) types among symptomatic foreskin tissue.
Consecutively excised symptomatic foreskins from 351 men were sent for histopathological evaluation. During the surgical procedure, a fresh biopsy was taken for HPV analysis by modified general primer polymerase chain reaction. A medical questionnaire regarding medication, smoking habits, number of lifetime sexual partners, former diseases and surgery performed on penis was completed by all participants.
The most common clinical diagnosis and cause for circumcision was phimosis, seen in 85.2%. Histopathologically inflammatory dermatological conditions were present in 87% of the men. The most common histopathological diagnosis was lichen sclerosus (LS) observed among 58.7%. Notably, penile intraepithelial neoplasia (PeIN) was present in 2% without former clinical suspicion. Overall, HPV was detected in 17.1% of the men and 28 different HPV types were found. High-risk (HR) HPV types were identified in 9.1% and HPV16 was present in 2.3%. Current smoking increased the risk of HPV (crude odds ratio [OR] 2.8, confidence interval [CI] 1.4-5.6; P = 0.005). Having >15 lifetime sexual partners increased the risk of HPV (crude OR 2.6, 95% CI 1.4-5.1; P = 0.003) and when adjusted for current smoking the OR was substantially increased (OR 6.0, 95% CI CI 2.2-16.8; P < 0001).
Histopathological evaluation of circumcised symptomatic foreskin revealed PeIN in 2% of the men without any clinical suspicion of malignancy and that treatable dermatological conditions were present in 87%, LS being the most common. HR-HPV types were present in 9%. Due to risk of malignant development both in PeIN and in inflammatory skin diseases we recommend sending all excised foreskins from patients with symptoms for histopathological evaluation as guidance for further clinical management.
调查有症状的包皮组织中病理疾病的流行情况和人乳头瘤病毒（HPV）类型谱。
连续切除 351 名男性的有症状的包皮组织，用于组织病理学评估。在手术过程中，通过改良的通用引物聚合酶链反应（PCR）对新鲜活检进行 HPV 分析。所有参与者都完成了一份关于用药、吸烟习惯、终生性伴侣数量、既往疾病和阴茎手术的医疗问卷。
最常见的临床诊断和包皮环切术原因是包茎，占 85.2%。组织病理学上有 87%的男性存在炎症性皮肤病。最常见的组织病理学诊断是硬化性苔藓（LS），占 58.7%。值得注意的是，2%的男性没有临床怀疑的情况下存在阴茎上皮内瘤变（PeIN）。总体而言，17.1%的男性 HPV 检测呈阳性，发现了 28 种不同的 HPV 类型。高危（HR）HPV 类型占 9.1%，HPV16 占 2.3%。目前吸烟增加了 HPV 的风险（粗比值比[OR]2.8，95%置信区间[CI]1.4-5.6；P=0.005）。有>15 个性伴侣会增加 HPV 的风险（粗 OR 2.6，95% CI 1.4-5.1；P=0.003），当调整为目前吸烟时，OR 显著增加（OR 6.0，95% CI 2.2-16.8；P<0001）。
对切除的有症状的包皮组织进行组织病理学评估显示，2%的男性没有任何恶性怀疑的 PeIN，而 87%的男性存在可治疗的皮肤病，最常见的是 LS。HR-HPV 类型占 9%。由于 PeIN 和炎症性皮肤病都有恶性发展的风险，我们建议对所有有症状的患者切除的包皮组织进行组织病理学评估，为进一步的临床管理提供指导。
