Peer-reviewed article
A paradigm shift in the surgical treatment of phimosis in pediatric patients: Is practice aligned with current recommendations?
S Fuentes, N Vicente-Sánchez, M E Martín-Castillo, E Robert-Gil, A Arranz-Martí et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed study examines surgical practices for phimosis (a foreskin condition) in children up to 18 years old, comparing actual practice against European and British pediatric urology guidelines. The researchers reviewed 222 surgical cases from 2022-2023 and found that while most procedures followed recommended protocols, a high percentage of asymptomatic cases in young children were operated on despite guidelines recommending surgery only for symptomatic cases. The authors suggest that clinical indications and optimal timing for intervention in asymptomatic cases should be reconsidered based on the potential for spontaneous resolution.
Key points
- 11% of cases involved pathological phimosis; 89% involved physiological phimosis
- 47% of physiological phimosis cases were asymptomatic, with 70% of these occurring in children aged 3-7 years
- All surgeries were performed on an outpatient basis with local anesthesia
- Current surgical practices comply with technical recommendations but may over-treat asymptomatic cases in young children
- Authors recommend reviewing indications and optimal age for surgery given potential for spontaneous resolution
Limitations
This is a clinical audit of surgical practice rather than an evaluation of child well-being outcomes. The document does not assess health impacts, quality of life, or long-term outcomes for affected children.
Abstract
INTRODUCTION: Improving the quality of care is a fundamental issue in medicine. The analysis of routine practice and its adequacy to the available evidence can detect areas for improvement. We have decided to apply these principles to the surgical treatment of phimosis in pediatric age. The aim of this study is to analyze the situation of phimosis surgery for children up to 18 years of age in our environment and its compliance with current recommendations. MATERIAL AND METHODS: Retrospective descriptive observational study including surgeries performed for phimosis in children and adolescents up to 18 years of age in 2022 and 2023. Data were compared with the recommendations of the European and British Pediatric Urology Associations. RESULTS: A total of 222 medical records were included. All surgeries were performed on an outpatient basis and with loco-regional anesthesia. The percentage of pathological phimosis was 11%. Among physiological phimosis, 47% were asymptomatic (70% between 3 and 7 years of age). DISCUSSION: According to current European recommendations, phimosis surgery is reserved for cases of symptomatic pathological or physiological phimosis or with increased risk of urinary tract infection. In pediatric patients in our environment, all aspects of phimosis surgery are performed according to current recommendations, but the percentage of asymptomatic phimosis operated on in young children is high. Based on the possibility of spontaneous resolution, the indication and optimal age of intervention in this group of patients should be reviewed.