Pediatrics Masthead

Foreskin disease in intact Danish males

This study by Ida Sneppen and Jørgen Thorup found that 1.7% needed "foreskin operation" for phimosis.  Given that all those having "foreskin operation" were under 17 most operations for "phimosis" were probably unnecessary.

0.37% had "BXO". Assuming that none of these could be treated by potent topical steroids this would imply that only 1 in 200 required circumcision - far less when the cases that could be treated by steroids is taken into consideration.


OBJECTIVE: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated the incidence and morbidity of foreskin surgery due to medical indications in boys from the Capital Region of Denmark in 2014.

METHODS: Medical records from all boys operated on the foreskin due to medical reasons in the Capital Region in 2014 were reviewed. Patients with hypospadias, ritual circumcision, and redo-surgery because of complications to nontherapeutic circumcision were excluded.

RESULTS: A total of 181 patients were included. The cumulative risk of undergoing foreskin operation before 18 years of age was 1.7%. Forty patients had histologic verified balanitis xerotica obliterans (BXO) corresponding to a total risk of 0.37% of developing BXO. Mean age at surgery was 10.1 years (range 1–17). Phimosis was the most frequently reported indication (95.0%). The remaining 5.0% underwent surgery because of frenulum breve causing problems during erection. Before surgery, 27.1% had foreskin-related voiding problems and 17.1% had at least 1 episode of balanitis. Circumcision was initially performed in 44 cases. The remaining 137 patients had a foreskin-preserving operation performed. Nine boys had secondary circumcision after initially having foreskin-preserving operation. Fifty patients initially had preputial histology performed. BXO was verified in 37 patients. Of the 9 patients with redo-surgery due to recurrent phimosis, a further 3 had histologically verified BXO.

CONCLUSIONS: Childhood foreskin-related problems in a region with no tradition of newborn male circumcision should not be neglected.

  • Accepted February 10, 2016.

See original [paywall] at Pediatrics

Keyword: Foreskin disease

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One comment

  • Dan Bollinger

    I took a hard look at this study, too, since it was carefully done and done within a foreskin preserving culture. As such, it is more likely to speak to the true nature of interventions than any previous study I know of.

    In a private communication with corresponding author Jorgen Thorup, he says that all the boys referred to the clinic because of phimosis (95%) were for pathological phimosis. The study also says that 55.2% had previously tried topical steroid cream. The researchers are quick to add that they could not know if the cream was used correctly, or if it could have helped the other portion. At this point, we must assume they were diligent, but qualify our statements going forward.

    My interpretation results in these take-aways:

    Denmark is a foreskin-preserving society. A Danish study found:
    Only 1 in 254 boys (or perhaps more) will require circumcision to treat a diagnosed condition by age 17.
    No child under the age of 1-year is likely to require circumcision to treat a diagnosed condition.

    Hope this helps, Dan