Longitudinal changes in glans fullness after circumcision in boys with phimosis: Association with age at surgery

Quantitative longitudinal data on postoperative glans morphology in children are limited, and the timeline of morphological changes and potential age-related variations remain poorly understood.

To characterize longitudinal changes in glans morphology after circumcision in boys with phimosis using the glans fullness index (FI), and to determine whether postoperative trajectories differ according to age at surgery.

In this prospective, single-arm longitudinal study, 135 boys aged 6-14 years undergoing circumcision for phimosis were evaluated using standardized measurements intraoperatively (baseline) and at 3, 6, and 12 months postoperatively.The FI was defined as the ratio of the mid-glans to the maximal transverse diameter to capture cross-sectional contour. Data were analyzed using linear mixed-effects models.

The FI increased modestly over time (P = 0.003), from 0.861 (95% CI 0.855-0.868) at baseline to 0.879 (95% CI 0.872-0.886) at 12 months(overall relative increase of ∼2.1%), reflecting a transition toward a rounder glans profile. The most substantial morphological changes occurred within the first 6 months (P < 0.05 at 6 and 12 months vs. baseline), plateauing thereafter. The longitudinal trajectory varied significantly with age at surgery (P < 0.001), with older boys exhibiting more pronounced increases in FI. All effect sizes were small to moderate.

These findings demonstrate a small but measurable postoperative shift in glans contour that stabilizes by approximately 6 months. However, the lack of an uncircumcised control group precludes separating surgical adaptation from normal physiological growth.

Glans morphology shows modest longitudinal changes after circumcision, with most change occurring within the first 6 months and stabilization thereafter. Postoperative trajectories vary with age at surgery.These findings describe postoperative longitudinal patterns and do not allow causal inference regarding the independent effect of circumcision as opposed to normal developmental processes.

These findings provide a practical framework for interpreting postoperative glans appearance after pediatric circumcision. Because contour changes are modest, age-related, and largely stabilize after 6 months, early appearance should not be overinterpreted. The 6-month follow-up may better support morphologic assessment, counselling, and longitudinal monitoring using FI, pending external validation.