6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Have been the incidence and consequences of penile lichen sclerosus still underestimated?

      editorial

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          We write to express our comments on the article which was published in this journal of Translational Andrology and Urology by Kwok et al. entitled “Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicenter retrospective cohort study” (1). The authors raised a very important topic concerning the incidence of lichen sclerosus (LS) in foreskins obtained during circumcision at 8 hospitals. Penile LS is a chronic and fibrotic dermatosis which often occurs on the prepuce and glans of the penis. Etiopathogenesis is unknown, but nowadays authors are more likely to suggest that occlusion and irritating effects of urine could be the main reason for LS formation (2-4). Moreover, microdribling incontinence in occlusion conditions could provide to higher gene expression of proinflammatory cytokines such as interleukin 1-A (IL-1A), interleukin 6 (IL-6) and interferon-gamma (INF-γ) which may confirm this hypothesis (2). Circumcision is curative in nearly 100% of cases of penile LS. Additionally, in phimosis (common LS complication) male circumcision not only relives subjective symptoms of phimosis (as LS complication) but improves the quality of sexual life (5). In the literature, there is a large discrepancy from 1% to 67.4% in the prevalence of LS in foreskins obtained during circumcision (6,7). For this reason, research on that subject is needed. However, we have some questions and comments to the article entitled “Prevalence and sequelae of penile LS in males presenting for circumcision in regional Australia: a multicenter retrospective cohort study”. The first question is: what is the real indication of circumcision in this study? The authors of the article mentioned that circumcision was generally undertaken in those presenting with symptomatic penile pathologies such as phimosis or penile infections. However, in the next paragraph authors pointed out that specimens are commonly referred for pathological analysis only when there is clinical concern for significant underlying abnormality. What do the authors understand by penile abnormality? Do they suggest that phimosis or penile inflammation are not abnormalities? Reliance only on clinical symptoms could provide bias because clinical diagnosis is not always accurate with histopathological examination. According to the data from the literature, the precision of clinical diagnosis (performed separately by urologist and dermatologist) in the case of phimosis was estimated only to be 67% (7). The second reservation is percent of foreskin specimens sent for pathological examination. For example, in the same region, Toowoomba in public hospitals only 24% (40/164) of specimens were sent for pathological examination, on the other hand in St Andrew’s and St Vincent’s Private Hospital Toowoomba was 100% (150/150). We wonder if the authors see such discrepancy. In our opinion, the research would be more transparent if the authors include only the hospitals where percent of foreskins sent for analysis was 100% [St Andrew’s and St Vincent’s Private Hospital Toowoomba was 100% (150/150); Mater Mackay Hospital was 100% (19/19)]. Finally, in the title, Tab. 1 and conclusion the high prevalence of LS (63.6%) was in foreskins analyzed by pathomorphologist but not in the patient presenting for circumcision, since only 313 (51.2%) from 611 foreskin specimens were sent to the pathologist. Supplementary The article’s supplementary files as 10.21037/tau-22-421

          Related collections

          Most cited references7

          • Record: found
          • Abstract: not found
          • Article: not found

          Lichen Sclerosus and Phimosis – Discrepancies Between Clinical and Pathological Diagnosis and Its Consequences

            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Male Circumcision Due to Phimosis as the Procedure That Is Not Only Relieving Clinical Symptoms of Phimosis But Also Improves the Quality of Sexual Life

            Introduction Male circumcision is recognized as the most effective method of phimosis treatment. Analyzing the literature, the information about the influence of male circumcision due to phimosis for patients' subjective symptoms such as itching, burning, penile pain, pain during intercourse, and quality of sexual life is insufficient. Aim To investigate the effect of male circumcision due to phimosis to patients' subjective symptoms, including erectile function and satisfaction with their genitals. Methods The single-center prospective study began in January 2018 and ended in January 2020. Sixty-nine male, adult patients, who were qualified for circumcision due to phimosis, were included in the study. Main Outcomes Measures The study outcomes were obtained using questionnaires such as visual analog scale 0-10 for itching, burning, penile pain, and penile pain during intercourse; International Index of Erectile Function (IIEF-5) and Male Genital Self Image Scale 7 (MGSIS-7) to assess the changes in patients sexual functioning. Results Before the circumcision of the 69 patients included in the study, 59 patients (86%) reported some subjective symptoms of phimosis. The most frequent and most severe complaint was pain during intercourse, then itching and burning of the penis. Penile pain at rest was the least frequent. After 3 months from circumcision, subjective symptoms almost completely disappeared. All of 69 patients declared to have a sexual partner. 3 months after circumcision, all patients achieved significant improvement in both obtaining and maintaining an erection based on IIEF-5 score. Their sexual intercourse was more satisfying for them. All patients suffering from phimosis were embarrassed about their genitals before surgery. 3 months after circumcision, satisfaction with genital self-image increased significantly. Conclusion Male circumcision due to phimosis is not only relieving the clinical symptoms of phimosis, but it also improves the quality of sexual life. Czajkowski M, Czajkowska K, Zarańska K, et al. Male Circumcision Due to Phimosis as the Procedure That Is Not Only Relieving Clinical Symptoms of Phimosis But Also Improves the Quality of Sexual Life. Sex Med 2021;9:100315.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients

                Bookmark

                Author and article information

                Journal
                Transl Androl Urol
                Transl Androl Urol
                TAU
                Translational Andrology and Urology
                AME Publishing Company
                2223-4683
                2223-4691
                August 2022
                August 2022
                : 11
                : 8
                : 1069-1070
                Affiliations
                [1 ]deptDepartment of Urology , Medical University of Gdańsk , Gdańsk, Poland;
                [2 ]deptDepartment of Dermatology, Venerology and Allergology , Medical University of Gdańsk , Gdańsk, Poland
                Author notes
                Correspondence to: Mateusz Czajkowski. Department of Urology, Medical University of Gdańsk, Mariana Smoluchowskiego 17 Street, Gdańsk 80-214, Poland. Email: drmatczajkowski@ 123456gmail.com .
                Article
                tau-11-08-1069
                10.21037/tau-22-421
                9459543
                36092835
                b085669c-e9c8-40c5-a2e8-f855dbade8fb
                2022 Translational Andrology and Urology. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 14 June 2022
                : 11 August 2022
                Categories
                Editorial

                Comments

                Comment on this article