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Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
1Department of Paediatric Urology, Royal Liverpool Children's Hospital.
Abstract:
Thirty thousand circumcisions are performed annually in England and 70% of these are upon boys under 15 years of age. In the Mersey Region some 950 boys are circumcised each year for medical indications, the commonest being 'phimosis', which accounts for 87% of cases, of whom almost one-half are under 5 years of age. Regional practice is compared with that of our Unit, where the majority of referrals had developmentally non-retractile foreskin rather than true phimosis, where circumcisions for phimosis and for balanoposthitis occurred in almost equal numbers, and where no example of true phimosis was seen in boys under 5 years of age. It appears that in the Mersey Region many boys are circumcised for development non-retractability of the prepuce rather than for true phimosis and that in consequence some two-thirds of the operations are unnecessary.
Insights
Many circumcisions performed on boys in England are unnecessary. Studies suggest two-thirds of medically indicated circumcisions for phimosis in the Mersey Region may be unwarranted, often for non-retractile foreskin in young children.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Circumcision is a common procedure in England, with a significant number performed on minors.
- Phimosis is a leading medical indication for circumcision in boys.
Purpose of the Study:
- To compare circumcision practices for medical indications between a regional cohort and a specific surgical unit.
- To evaluate the appropriateness of circumcisions performed for phimosis, particularly in young boys.
Main Methods:
- Retrospective analysis of circumcision data from the Mersey Region and a single surgical unit.
- Comparison of patient demographics and indications for circumcision, focusing on phimosis and non-retractile foreskin.
Main Results:
- In the Mersey Region, 950 boys undergo circumcision annually for medical reasons, predominantly phimosis (87%).
- A substantial proportion of these circumcisions (nearly half) are on boys under five years old.
- The surgical unit observed that most referrals were for developmentally non-retractile foreskin, not true phimosis, with equal numbers of circumcisions for phimosis and balanoposthitis. No true phimosis was noted in boys under five.
Conclusions:
- A significant number of circumcisions for phimosis in the Mersey Region may be unnecessary.
- Many circumcisions appear to be performed for non-retractile foreskin rather than true phimosis, especially in younger age groups.
- Current regional practices suggest potential over-treatment and unnecessary surgical interventions.