Time to rethink routine histopathology after adult circumcision? Long-term oncological outcomes from an 11-year cohort.

purposeTo evaluate whether routine histopathological examination of the prepuce following adult circumcision without clinical suspicion of malignancy influences patient management and healthcare resource utilisation, and to report circumcision frequency and long-term oncological outcomes.

methodsA retrospective cohort study was conducted of all adult circumcisions performed between January 2015 and December 2025. Patients aged ≥ 15 years undergoing circumcision for symptomatic phimosis, paraphimosis, or recurrent balanitis were included. Cases with suspected malignancy or known premalignant lesions were excluded. Demographic, operative, histopathological, and follow-up data were extracted from electronic records. Median follow-up was 85 months. Cost analysis was based on an estimated histopathology cost of £226 per specimen.

resultsOf 1,648 listed patients, 1,523 met the inclusion criteria (median age 44 years). Phimosis was the primary indication (98.2%). Lichen sclerosus was identified in 62% of specimens, while incidental penile intraepithelial neoplasia (PeIN) was detected in 0.5%. No invasive carcinomas were identified. All PeIN cases were managed with circumcision alone, and no progression or additional intervention was required at a median follow-up of 81 months. Eliminating routine histopathology would have saved 304.6 consultant hours and £344,198 over 11 years (£31,291 annually).

conclusionsIn the absence of clinical suspicion, routine histopathological examination of the prepuce rarely detects clinically significant malignancy or alters management. A selective, risk-adapted approach may optimise resource utilisation while maintaining oncological safety.