Supplementary file to Øster and "The Validity of Routine Medical Checks"

Except where Schöberlein quotes Saitmacher and Ludvigsson quotes Bokström. The only reference sources appear to be Øster and Gairdner

Thirteen Studies since 1980 quoting or misquoting Øster

Jacob Øster in "Further Fate of the Foreskin" Archives of Disease in Childhood (published by the British Medical Association), April 1968. 43:p.200-203. wrote :
"phimosis was found . . . with a diminishing incidence throughout the years, from 8% in 6-7 year-olds to 1% in 16-17 year-olds. in addition, tight prepuce was present in 2%." He also reports "3% in 16-17 years-old" had adhesions. Øster reminds us : "The presence and extent of preputial adhesions could obviously only be assessed in those cases where no phimosis was present."

CAMBELL'S UROLOGY Cambell M.F. Seventh Edition London W.B. Saunders 1998 PART IX PEDIATRIC UROLOGY Chapter 69 Congenital Anomalies of the Genitalia Jack S. Elder, M.D. pages 2120-2144

"By 3 years of age, 90% of foreskins are retractable, and less than 1% of males have phimosis by 17 years of age (Oster 1968)"

REPORTING on SPONTANEOUS or NATURAL RETRACTION
Andrew Gordon and Jack Collin "Save the Normal Foreskin" British Medical Journal Vol.306:1-2, January 2nd. 1993
"the incidence of spontaneously retractile foreskin increased yearly until by 17 years only 1% remained non-retractile."

JP Warren FRCP, and J Bigelow PhD, "The Case Against Circumcision" British Journal of Sexual Medicine, Sept/Oct 1994
"Øster described what happens to the remaining 10% and showed that if these penises were not interfered with, natural separation would follow in all but 1% by the age of 17."

Dewan PA, Tieu HC, Chieng BS Phimosis: is circumcision necessary? J Paediatr Child Health 1996 Aug;32(4):285-9
"Gairdner and Oster found that the prepuce is retractable in only 4% of newborn males, 20% at age 6 months, 50% at 1 year, 90% at 3 years and 99% at 17 years of age."

H.L. Tan (FRACS), Foreskin fallacies and phimosis. Ann Acad Med Singapore 14(4), 626-630 (1985)
"Øster states that full retractability does not occur until early teenage years. 3% of 16 year olds surveyed by him still had incompletely retractable foreskin, which subsequently became retractable at 17."

REPORTING on the INCIDENCE OF PHIMOSIS
Lindhagen T. - Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Eur-J-Surg. 1996 Dec; 162(12): 969-72
"Persistant phimosis is observed in 8% of 6-7 year olds, with an incidence which decreases to 1% in boys 16-17 years of age (ref)"

Golubovic-Z; Milanovic-D; Vukadinovic-V; Rakic-I; Perovic-S "The conservative treatment of phimosis in boys." Br-J-Urol. 1996 Nov; 78(5): 786-8
"The incidence of phimosis decreases from 8% to 1% in adolescence (ref)"

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
" Oster recorded a decrease in phimosis with age (1% between 16 - 17 yrs. old)"

OJ. Clemmensen et al - The histologic spectrum of prepuces from patients with phimosis. - Am J Dermatopathol 1988 Apr;10(2):104-8
"In his series of 1968 schoolboys examined anually, Oster (13) found a spontaneously decreasing incidence of phimosis from age 6-7 years (8%) to age 16-17 years (1%). Three cases required surgery, and the phimosis was in all cases acquired during the observation period. Oster suggests that an expectant attitude may be preferable to circumcision, and our findings of a normal histology in many of the young boys supports his view."

TWO NEW READINGS
Herzog LW - Alvarez SR - The frequency of foreskin conditions in uncircumcised children. Am J Dis Child 1986 Mar;140(3):254-6
"A review of the British literature provides some data on the frequency of phimosis (4% to 10%) ... and adhesions (33% of school-age children)." .... "Oster found 96% of schoolboys had a fully retractable foreskin."

Kayaba H et al. Analysis of shape and retractibility of the prepuce in 603 Japanese boys. J Urol 156(5), November 1996, 1813-1815
"Oster ... reported that the incidence of preputial adhesion decreased frpom 70% at ages 6 to 7 years to 5% at 16 to 17 years.
In most male individuals preputial separation continues until adolescence, presumably to protect the immature glans penis." (My note: This is logical : 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 matured).

WITHOUT any ESTIMATION of STATISTICS
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
"Our observations support the conclusions given by Gairdner and Oster that unnecessary operations and even harmful complications can be avoided if the normal development of the prepuce is patiently awaited."

AM Rickwood et al Phimosis in boys Br J Urol 1980 Apr;52(2):147-50
" ... Gairdner (1949) demonstrated that in young boys non-retractability of the foreskin is a normal finding and is due to the persistence of developmental adhesions between the glans and prepuce. These break down spontaneously with the passage of time and, without interference, full retractability of the foreskin can be expected in almost all boys by their early teens (Oster 1968). Non-retractability of this type requires no treatment ... "

Shankar KR, Rickwood AM The incidence of phimosis in boys. BJU Int 1999 Jul;84(1):101-2
"Although such "physiological phimosis" is almost always self-resolving [3]," (ref to Oster) - (see also Critique of Shankar, Rickwood)

Øster (ibid) wrote in his summary : "Phimosis is seen to be uncommon in schoolboys, and the indications for operation even rarer if the normal development of the prepuce is patiently awaited.".

Andrew Gordon and Jack Collin (ibid) Report that Øster's findings, when discussing ballooning : ". . suggest that if this physical sign is ignored the symptoms will resolve as the foreskin becomes spontaneously retractile." Øster never mentions ballooning! (see Criticism of Gordon and Collin)

Dr. B. Spock and Dr. Michael B. Rothenberg "Dr. Spock's Baby and Child Care for the Nineties" Simon and Schuster Inc. (1992) p.225-226 "It may take . . some boys . . until adolescence, to have a fully retractable foreskin, but this is no cause for concern." (no references)