Post-Circumcision Assessment and Management

Follow-Up Protocol

The British Journal of Dermatology recommends post-circumcision assessment to include evaluation for bleeding, infection, wound healing, and urinary function, with follow-up at 3 months to assess for residual disease, particularly in cases where circumcision was performed for lichen sclerosus 1, 2
For circumcisions performed for lichen sclerosus, follow-up should occur at 3 months after circumcision to record symptoms relating to sexual and urinary function, and to examine for residual disease on the glans and in the coronal sulcus 2
The British Journal of Dermatology suggests examining for residual disease on the glans and in the coronal sulcus, which may require further treatment with topical steroids, and reviewing histopathology results from the circumcision specimen to confirm diagnosis and exclude penile intraepithelial neoplasia (PeIN) or squamous cell carcinoma (SCC) 2, 3, 4

Patients whose circumcision cured their disease can be discharged after the post-operative follow-up visit, according to the British Journal of Dermatology and The Journal of Urology 2, 5
Patients with active ongoing disease will require long-term follow-up to assess symptoms and examine for changes suggestive of PeIN or SCC, as recommended by the British Journal of Dermatology 2, 6

Boys who underwent circumcision for lichen sclerosus should be reviewed to assess for residual disease, and obese children and those with previous surgical interventions are at greater risk for persistent disease, according to the British Journal of Dermatology 3
All tissue removed during pediatric circumcision should be sent for pathological review, as suggested by The Journal of Urology 7

Patients with lichen sclerosus should be educated that disease may recur after many years and they should seek referral if signs of recurrence develop, as recommended by the British Journal of Dermatology 2