Does routine histology alter management post circumcision?

• Published in: Journal of clinical urology 2020-07, Vol.13 (4), p.279-282
• Main Authors: Kerr, Lynne, Hendry, Jane, Crookshanks, Aaron, Taylor, Joby
• Format: Article
• Language: English
• ISSN: 2051-4158; 2051-4158; 2051-4166
• DOI: 10.1177/2051415819895399

Objective: Circumcision is a commonly performed urological procedure, histology is often requested with unexpected malignancy cited as the reason. This paper aims to determine if routine histology following circumcision alters the clinical management of patients. Patients and methods: The clinical records of 508 consecutive adult patients circumcised at a district general hospital between 1/1/12 and 31/12/16 were retrospectively reviewed. Two groups were available for comparison, those with histological diagnosis (359 patients) and those with a clinical diagnosis only (149 patients). The following data were collected: indication for circumcision; preoperative clinical and histological diagnosis; patient follow-up (mean 40 months). Results: A total of 508 patients were reviewed. Histology was requested for 359 specimens (70.7%). Six cases of squamous cell carcinoma were correctly identified clinically and there were no cases of unexpected malignancy. The clinical diagnosis of lichen sclerosus was correct in 92% of cases; 39 patients were re-referred following discharge, only one required further management of a urethral stricture. Conclusion: The results of our study show there is no difference in the outcomes or re-referral rates of patients who have routine histology requested following circumcision compared with those who do not. Clinical diagnosis is consistently accurate. There is a minimal number of patients referred back to the service, even with lichen sclerosus, and histology does not affect the rate of this. We conclude that routine histology does not alter patient management following circumcision and is not required unless a clinical suspicion of malignancy exists. This study represents the largest cohort of circumcision patients and includes the longest period of follow-up to add to the current body of literature. Levels of evidence: 2b retrospective consecutive cohort study with follow up.