SIX RECENT STUDIES GIVING STATISTICS FOR PHIMOSIS AMONG BOYS and INFANTS

ANALYSIS
The observations support the general trend of decrease in frequency with age however when added together these 6 recent studies cover a sample of at most 167 boys over the age of 11 yrs.

SUMMARY

Lau studied 1,196 uncircumcised children. All babies a non-retractable foreskin. ... 21% in the 3-4 years old group. ... ... less than 10% in the children after 8 years old were still having phimosis. In the 11-12 years old group the incidence was 4.4% (My note: In the 11-12 years old group the incidence refers to 3 cases in a sample of 68). "Preputial adhesions ... The incidence of complete preputial retraction increased rapidly after 6-7 years old; after 10 years old this incidence increased to over 80%"

Kayaba showed among 600 boys, a completely retracable prepuce gradually increased from 0% at age 6 months to 62.9% by 11 to 15 years, while that of a tight ring decreased with age from 84.3% to 8.6% (My note: there were only 35 studied cases among the 11-15 yr. olds)

Herzog studied 259 - 272 (?) uncircumcised boys and reported 65 boys between 6 and 12 yrs.old and a 9% phimosis rate

Branger provides data on the outcome after forcible retraction." The common occurrence of this painful practice may have relieved many cases of phimosis though I question the healing value of any such painful process. Among 500 nursery school children 182 (36.4%) children had a history of forceful retraction. 318 (63.6%) had not undergone this painful process. Of these 318:- 204 had a fully retractable prepuce (64.9%), 99 had adhesions (56 of little importance, 43 covering half of the glans)-(31.1%), and 13 had phimosis (4%).

Fergusson compares the different general problems between circumcised and uncircumcised boys among a group of more than 500 children. He reported phimosis occurred at 3.7% in boys under 8 yrs. old. "However episodes for which the child was brought to medical attention for "tight" or nonretractable" foreskin but was not treated were not classified as phimosis,"

PC. Mishra et al., Normal anatomic variants in the newborn. Indian Pediatr 1985 Sep;22(9):649-52
This study deals with some preliminary observations on normal anatomic variants in 350 newborns ... "Phimosis if present was noted for its degree of severity. Phimosis was observed in 4.3% (15) cases only and degree of prepucial phimosis varied."
My note: from Table I it is clear that of the 350 studied cases only 195 were male, therefore an incidence of 15 cases would result in 7.7% and not 4.3%.

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Lau, JTK and Ching, RML. An outpatient observation of the foreskin among Chinese Children in Hong Kong. Singapore Med. J. 1982 Apr; 23(2): 93-96

1,235 male children below the age of twelve attended the Sai Ying Pun General Outpatient Clinic. All were ethnic Chinese.

Preputial retraction was attempted; failure of retraction and glandular-preputial adhesions were recorded. Phimosis or nonretractability was defined as tightness of the preputial orifice which prevented retraction of the foreskin to expose the glans, by gentle but steady manipulation.

Of the 1,235 children under 12 years old examined, 41 children were circumcised. ... Fourteen children had therapeutic circumcisions

All the 68 babies under the age of 6 months were found to have a non-retractable foreskin. This incidence decreased rapidly between 6 months and the 2 years of age, and dropped to 21% in the 3-4 years old group. The incidence decreased gradually thereafter and less than 10% in the children after 8 years old were still having phimosis. In the 11-12 years old group the incidence was 4.4%

My note: In the 11-12 years old group the incidence 4.4% refers to 3 cases in a sample of 68

"Preputial adhesions ... The incidence of complete preputial retraction increased rapidly after 6-7 years old; after 10 years old this incidence increased to over 80%"

Our observations support the conclusions given by Gairdner and Øster.

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Kayaba H et al. Analysis of shape and retractibility of the prepuce in 603 Japanese boys. J Urol 156(5), November 1996, 1813-1815

Preputial retractability and formation of a tight ring were evaluated in 603 Japanese boys 0 to 15 years old. (average age 3.8)

Of the 603 boys 3 were excluded from study due to previous surgery for phimosis.

None of the 111 boys younger than 1 year had a fully retractable prepuce.

The incidence of a completely retracable prepuce gradually increased from 0% at age 6 months to 62.9% by 11 to 15 years, while that of a tight ring decreased with age from 84.3 to 8.6% Nine boys had balanoposthitis. (My note: there were only 35 studied cases among the 11-15 yr. olds)

These findings indicater that incomplete preputial separation is common and normal in neonates and infants, and preputial separation progresses until school age.

In most male individuals preputial separation continues until adolescence, presumably to protect the immature glans penis.

My note: It is logical that boys have an immature glans penis if it has never been exposed - most boys can retract their foreskin and this allows their glans to become a little hardened to life`s realities.

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Herzog LW - Alvarez SR - The frequency of foreskin conditions in uncircumcised children. Am J Dis Child 1986 Mar;140(3):254-6

Herzog compares the different problems between circumcised and uncircumcised boys

We performed a retrospective survey to determine the frequency of problems of the foreskin among uncircumcised children. Among 545 boys aged 4 months to 12 years, there were 272 uncircumcised boys and 273 control patients who were circumcised at birth.

The study was carried out in two primary care clinics serving an inner population. We questioned the parents of all boys between the ages of 4 months and 12 years attending the clinic for health supervision visits.

the children were examined for the presence of phimosis (nonretractable foreskin) or adhesions. For cases in which complications were reported, we reviewed the medical record to confirm diagnosis. Only the cases in which diagnosis was confirmed were included.

Phimosis was considered to be a complication only when a patient had symptoms, such as dysuria, that were attributed to the phimosis by a physician.

Paraphimosis occurred in two patients and symptomatic phimosis in eight.

Of the patients who were not circumcised at birth (N = 272), 22 patients (8%) were circumcised late. Eleven circumcisions were done for medical reasons ... Eleven were done without medical indication.

quotes Øster "the fequency of phimosis (4% to 10%)

Gairdner found that 50% had a fully retractable foreskin by age 1 year and 80% by age 2 years. Øster found 96% of schoolboys had a fully retractable foreskin. Our results were similar.

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Branger B et al. Examen du prepuce chez 511 enfants en maternelle. Role des manoeuvres de decalottage.- [Examination of the prepuce in 511 nursery school children. The role of retraction technics] Ann Pediatr (Paris) 1991 Nov;38(9):618-22

As the abstract indicates: "This retrospective study in a pediatric population of mean age 3 years 7 months provides data on the outcome after forcible retraction."

The foreskin of 511 nursery school children was examined. Among the 500 unoperated children,"182 (36.4%) children had a history of forceful retraction.318 (63.6%) had no interferance. Of these 318, 204 had a fully retractable prepuce (64.9%), 99 had adhesions (56 of little importance, 43 covering half of the glans)-(31.1%), and 13 had phimosis (4%).

The study does not tell us how many cases of phimosis which forceful retraction actually cured.

"it is possible that the definition of phimosis is not the same for all the authors"

quotes Øster as 1% at 16-17 years

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Fergusson DM AU- Lawton JM AU- Shannon FT TI- Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988 Apr;81(4):537-41

Fergusson compares the different problems between circumcised and uncircumcised boys

The prevalence of penile problems was examined in a birth cohort of more than 500 New Zealand children studied ...at birth, 4 months, and annual intervals until the age of 8 years.

The aims of this research was twofold: (1) to examine the association batween the child`s neonatal circumcision status and risks of penile problems during early and middle childhood and (2) to adjust ... the potentially confounding effects of a number of social and perinatal factors.

Phimosis occurred at 3.7% in boys aged 0-8 yrs. old. however:

... (2) the number of episodes of phimosis experienced by the child. These episodes included all times the child sought medical attention for phimosis and associated symptoms. However episodes for which the child was broght to medical attention for "tight" or nonretractable" foreskin but was not treated were not classified as phimosis, because it was likely that most of these attendances were the result of parental anxiety or uncertainty about the development of the foreskin rather than any pathological condition in the child