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Prevalence of Phimosis in Males of All Ages: Systematic Review
Brian J Morris1, Jim G Matthews2, John N Krieger3
1School of Medical Sciences and Bosch Institute, University of Sydney, New South Wales, Australia.
Insights
Phimosis, or the inability to retract the foreskin, is common in newborns but usually resolves. Adult phimosis prevalence is estimated at 3.4%, with significant variation possibly due to treatment approaches.
Area of Science:
- Urology
- Andrology
- Public Health
Background:
- Phimosis is common in newborns and typically resolves within a few years.
- Persistent phimosis can lead to pain, sexual dysfunction, inflammation, and increased cancer risk.
- Primary phimosis is congenital, while secondary phimosis can result from conditions like lichen sclerosis, diabetes, or obesity.
Purpose of the Study:
- To systematically review and determine the prevalence of phimosis across different age groups.
- To synthesize existing data on phimosis incidence and resolution.
- To identify factors influencing phimosis prevalence in various populations.
Main Methods:
- A systematic literature search was conducted using PubMed, Google Scholar, and the Cochrane Library.
- Studies with original data on phimosis at any age were included.
- Data extraction and quality assessment were performed independently by two reviewers.
Main Results:
- Forty-three studies were included, analyzing data from newborns to adults.
- Phimosis prevalence was high in newborns, decreasing significantly with age.
- In adult males (≥18 years), 962 out of 17,136 had phimosis, with a pooled prevalence of 3.4% (95% CI 1.8-6.6).
Conclusions:
- Phimosis resolution is a lengthy process, influenced by spontaneous healing and clinical interventions.
- The wide range of adult phimosis prevalence may indicate differences in foreskin-preserving treatment strategies.
- Further research into age-specific prevalence and treatment outcomes is warranted.
Context:
Phimosis is considered virtually universal in newborn males and likely to resolve within a few years. Persistent phimosis can result in pain, sexual dysfunctions, increased risk of penile inflammatory conditions and penile cancer. There are two forms - primary phimosis and secondary phimosis - the latter often representing a consequence of lichen sclerosis, diabetes and obesity.
Objectives:
To conduct a systematic review to determine the prevalence of phimosis at different ages.
Data Sources:
PubMed, Google Scholar, the Cochrane Library, and bibliographies of original studies were searched using the keyword phimosis.
Study Selection:
Studies containing original data on phimosis at any age.
Data Extraction:
Two reviewers independently verified study design, extracted data and rated studies for quality.
Results:
Forty-three eligible studies were included: 27 from PubMed, 4 from Google Scholar, and 12 from bibliography searches. Phimosis was reported in most newborns, then gradually decreased in prevalence. Most studies did not differentiate primary from secondary phimosis, so values reported were net phimosis prevalence. There were 13 studies with data for males age ≥18 years. In all, 962 of 17,136 men had been diagnosed with phimosis (range 0.5%-13%). A random effects model found risk of phimosis in men was 3.4% (95% CI 1.8-6.6).
Conclusion:
Phimosis takes many years to resolve. Apart from spontaneous resolution, clinical interventions also contribute to the gradual reduction in prevalence among uncircumcised boys. The wide range of phimosis prevalence reported in adulthood may reflect variability in the extent of foreskin-preserving treatment of phimosis in different study cohorts.
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