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Phimosis - Are we on right track?

Aditya Arvind Manekar1, Narahari Janjala1, Subrat Kumar Sahoo1

  • 1Department of Paediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

African Journal of Paediatric Surgery : AJPS
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Summary

Paediatricians often confuse phimosis with physiological adhesions, leading to unnecessary referrals and circumcisions. Increased awareness and training on proper management can help address this common paediatric condition effectively.

Keywords:
Circumcisionphysiological adhesionstopical steroids

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Area of Science:

  • Paediatric Urology
  • Medical Education
  • Clinical Practice

Background:

  • Phimosis, the inability to retract foreskin, is a common paediatric condition.
  • Confusion exists between phimosis and physiological preputial adhesions.
  • This confusion leads to frequent, often unnecessary, referrals to surgeons.

Purpose of the Study:

  • To assess paediatricians' awareness regarding phimosis management.
  • To identify gaps in knowledge and practice concerning phimosis in children.

Main Methods:

  • A Google Forms questionnaire was distributed across India.
  • Responses were collected from paediatric residents, faculty, and private consultants.
  • Data from 221 participants were analyzed.

Main Results:

  • Most paediatricians (62.9%) refer phimosis cases directly to surgeons, despite awareness of conservative management (94.2%).
  • Many (43%) believe in routine circumcision counselling, and a significant portion order unnecessary investigations like ultrasounds (60.2%) and urine tests (70.1%).
  • Despite advocating delayed surgery (71.5% wait 1 year), 76% believe all cases need surgical referral, with only 58.8% following up.

Conclusions:

  • Paediatricians can manage physiological phimosis, reducing unnecessary surgical referrals.
  • Enhanced training is crucial to improve paediatricians' understanding and management of phimosis.
  • This can lead to avoiding unnecessary circumcisions and optimizing patient care.