Getúlio Vargas Filho Children´s Hospital, Niterói, Rio de Janeiro, Brazil.
Clementino Fraga Filho University Hospital, UFRJ, Rio de Janeiro, Brazil.
J Pediatr Urol. 2022 Aug;18(4):529.e1-529.e6. doi: 10.1016/j.jpurol.2022.06.030. Epub 2022 Jul 6.
The incidence of preputial lichen sclerosus (PLS) among children presenting with phimosis varies from 10 to 95%, depending on the age, the protocol for the treatment of pediatric phimosis, the method of diagnosis (clinical versus histological), and case mix (congenital versus acquired phimosis).
PLS may not be clinically obvious. Our aim is to show that a systematic histological examination of the prepuce may diagnose PLS in clinically unsuspected cases.
Prospective observational study of the histology of all prepuces resected from boys undergoing circumcision for phimosis but not clinically suspected to have PLS.
PLS was diagnosed histologically in 22 boys (32%). Boys with PLS were significantly older (mean 8.4 versus 4.7 years old). Diagnosis of PLS was not related to the degree of phimosis (summary figure). In three patients (grade 4 phimosis) glans discoloration was observed during surgery, and all had PLS. Follow up for boys found to have PLS ranged from 1 to 10 years. One patient developed recurrent phimosis, attributed to inappropriate conservative resection, and required further surgery. There were no cases of meatal stenosis.
Subtle cases of PLS may be difficult to detect clinically. Children are frequently asymptomatic, except for being unable to retract the prepuce. Physical examination has a low negative predictive value for the diagnosis of PLS. Complete removal of the prepuce with permanent glans exposure is regarded as essential to cure PLS and to avoid recurrent phimosis, but our patients were treated with partial circumcisions for cultural reasons. Only one needed reoperation for recurrent phimosis.
Histological PLS was present in approximately 1/3 of boys with phimosis, frequently without typical manifestations. Those patients may be cured with partial circumcisions.
在因包茎就诊的儿童中，其包茎性包皮口过紧（PLS）的发病率为 10%至 95%，具体取决于年龄、小儿包茎的治疗方案、诊断方法（临床与组织学）以及病例组合（先天性与获得性包茎）。
PLS 可能不会在临床上表现明显。我们旨在展示，对行包茎环切术的男孩的包皮进行系统的组织学检查，可能会在临床上未怀疑有 PLS 的情况下诊断出 PLS。
对因包茎而行包茎环切术但临床上未怀疑有 PLS 的所有男孩的包皮进行组织学前瞻性观察性研究。
22 名男孩（32%）的包皮组织学诊断为 PLS。患有 PLS 的男孩年龄明显较大（平均 8.4 岁比 4.7 岁）。PLS 的诊断与包茎的严重程度无关（摘要图）。在 3 名（包茎 4 级）手术中发现龟头变色的患者中，均诊断为 PLS。发现患有 PLS 的男孩的随访时间为 1 至 10 年。1 名患者因保守性切除不当而出现复发性包茎，需要进一步手术。无尿道狭窄病例。
隐匿性 PLS 可能难以在临床上发现。儿童通常无症状，除了无法向后翻包皮。体格检查对 PLS 的诊断具有较低的阴性预测值。将包皮完全切除并永久性暴露龟头被认为是治愈 PLS 并避免复发性包茎的关键，但由于文化原因，我们的患者接受了部分包皮环切术。仅 1 例因复发性包茎而再次手术。
在因包茎就诊的男孩中，约有 1/3 的存在组织学 PLS，常无典型表现。这些患者可通过部分包皮环切术治愈。
