Trends in paediatric circumcision and its complications in England between 1997 and 2003

British Journal of Surgery - Tập 93 Số 7 - Trang 885-890 - 2006
Paul Cathcart1, Martin Nuttall1, Jan van der Meulen1,2, Mark Emberton1,3, Simon Kenny4,5
1Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
2Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
3Institute of Urology and Nephrology, University College London, UK
4British Association of Paediatric Surgeons Clinical Outcomes Committee, UK
5Department of Paediatric Surgery, Royal Liverpool Children’s Hospital, Liverpool, UK

Tóm tắt

AbstractBackgroundIt has been suggested that too many English boys undergo circumcision. This report describes how circumcision rates have changed in England between 1997 and 2003, including data on complication rates and on how age, medical indication and surgical specialty affect postoperative haemorrhage rates.MethodsData were extracted from the Hospital Episode Statistics database of admissions to National Health Service hospitals in England. Patients were included in the study if an Office of Population Censuses and Surveys version 4 code for circumcision was present in any of the operative procedure fields of the database; 75 868 boys below 15 years of age were included in the study.ResultsCircumcision rates declined by about 20 per cent, from 2·6 per 1000 boys per year in 1997 to 2·1 in 2003. Between 2000 and 2003, circumcision rates remained static at 2·1 per 1000 boys per year. Circumcision rates fell by 31·2 per cent for boys aged 0–4 years, 9·3 per cent for boys aged 5–9 years and increased by 7·7 per cent in boys aged 10–14 years; 90·2 per cent of circumcisions were done for phimosis and 1·2 per cent of boys experienced a complication.ConclusionCircumcision rates in England continued to fall up until 2000, particularly in those aged under 5 years, in whom pathological phimosis is rare. The circumcision rate remains five times higher than the reported incidence of Phimosis.

Từ khóa


Tài liệu tham khảo

Dewan, 1996, Phimosis: is circumcision necessary?, J Paediatr Child Health, 32, 285, 10.1111/j.1440-1754.1996.tb02554.x

Circumcision policy statement, 1999, American Academy of Pediatrics. Task Force on Circumcision, Pediatrics, 103, 686

Rickwood, 2000, Towards evidence based circumcision of English boys: survey of trends in practice, BMJ, 321, 792, 10.1136/bmj.321.7264.792

Frisch, 1995, Falling incidence of penis cancer in an uncircumcised population (Denmark 1943–90), BMJ, 311, 1471, 10.1136/bmj.311.7018.1471

Nelson, 2005, The increasing incidence of newborn circumcision: data from the nationwide inpatient sample, J Urol, 173, 978, 10.1097/01.ju.0000145758.80937.7d

Rickwood, 1999, Medical Indications for circumcision, BJU Int, 83, 45, 10.1046/j.1464-410x.1999.0830s1045.x

Spilsbury, 2003, Routine circumcision practice in Western Australia 1981–1999, ANZ J Surg, 73, 610, 10.1046/j.1445-2197.2003.t01-1-02715.x

Rickwood, 1989, Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?, Ann R Coll Surg Engl, 71, 275

Shankar, 1999, The incidence of phimosis in boys, BJU Int, 84, 101, 10.1046/j.1464-410x.1999.00147.x

Speert, 1953, Circumcision of the newborn; an appraisal of its present status, Obstet Gynecol, 2, 164

Patel, 1966, The problem of routine circumcision, Can Med Assoc J, 95, 576

World Health Organization, 1994, International Classification of Diseases, 10th

Office for Population Censuses and Surveys, 1987, Classification of Surgical Operations and Procedures, 4th

Wilkes, 1990, Current trends in routine newborn male circumcision in New York State, N Y State J Med, 90, 243

Alanis, 2004, Neonatal circumcision: a review of the world's oldest and most controversial operation, Obstet Gynecol Surv, 59, 379, 10.1097/00006254-200405000-00026

To, 1998, Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection, Lancet, 352, 1813, 10.1016/S0140-6736(98)02392-7

Wiswell, 1989, Risks from circumcision during the first month of life compared with those for uncircumcised boys, Pediatrics, 83, 1011, 10.1542/peds.83.6.1011

Metcalf, 1983, Circumcision. A study of current practices, Clin Pediatr, 22, 575, 10.1177/000992288302200811

Griffiths, 1985, A prospective survey of the indications and morbidity of circumcision in children, Eur Urol, 11, 184, 10.1159/000472487

Kaplan, 1983, Complications of circumcision, Urol Clin North Am, 10, 543, 10.1016/S0094-0143(21)01717-1

Williams, 1993, Complications of circumcision, Br J Surg, 80, 1231, 10.1002/bjs.1800801005