Abstract
Context
Phimosis is considered virtually universal in newborn males and likely to resolve
within a few years. Persistent phimosis can result in pain, sexual dysfunctions, increased
risk of penile inflammatory conditions and penile cancer. There are two forms – primary
phimosis and secondary phimosis – the latter often representing a consequence of lichen
sclerosis, diabetes and obesity.
Objectives
To conduct a systematic review to determine the prevalence of phimosis at different
ages.
Data Sources
PubMed, Google Scholar, the Cochrane Library, and bibliographies of original studies
were searched using the keyword phimosis.
Study Selection
Studies containing original data on phimosis at any age.
Data Extraction
Two reviewers independently verified study design, extracted data and rated studies
for quality.
Results
Forty-three eligible studies were included: 27 from PubMed, 4 from Google Scholar,
and 12 from bibliography searches. Phimosis was reported in most newborns, then gradually
decreased in prevalence. Most studies did not differentiate primary from secondary
phimosis, so values reported were net phimosis prevalence. There were 13 studies with
data for males age ≥18 years. In all, 962 of 17,136 men had been diagnosed with phimosis
(range 0.5%–13%). A random effects model found risk of phimosis in men was 3.4% (95%
CI 1.8–6.6).
Conclusion
Phimosis takes many years to resolve. Apart from spontaneous resolution, clinical
interventions also contribute to the gradual reduction in prevalence among uncircumcised
boys. The wide range of phimosis prevalence reported in adulthood may reflect variability
in the extent of foreskin-preserving treatment of phimosis in different study cohorts.
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Article info
Publication history
Published online: October 23, 2019
Accepted:
October 15,
2019
Received:
August 14,
2019
Footnotes
Financial Disclosure: Brian J Morris is a member of a not-for-profit professional, government-registered, medical association, the Circumcision Academy of Australia, which makes available on its website evidence-based educational material on male circumcision, together with contact information about medical practitioners who perform circumcision in Australia. He does not receive income from this organization. John N Krieger provided advice and supported the legal help to University of Washington for the patenting of a circumcision device. He did not receive any income from this.
Funding: None.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
