AAP: Need to Re-Do Circumcision Rises, Reasons Unclear

October 30th, 2011 Posted in Medical

BOSTON — An unexplained increase in the number of revision circumcisions has pediatric urologists wondering whether the finding is real and, if so, what caused it.

Data contributed by pediatric hospitals nationwide showed a 119% increase in the rate of revision circumcision procedures from 2004 to 2009.

In contrast, the rate of primary circumcision increased by 19%, and procedures to remove penile adhesions rose by 37%.

Closer inspection of the data showed wide variation by hospital in the rate of revision circumcision during the study period, Paul J. Kokorowski, MD, reported here at the American Academy of Pediatrics meeting.

“We found that certain hospitals had dramatic rises in revision circumcision procedures [approaching 1,000% in some cases] while others had more modest increases,” said Kokorowski, of Children’s Hospital Boston.

“Only three hospitals showed stable rates or slight decreases,” he said.

Anecdotal evidence has suggested that an increased frequency of revision circumcision in recent years, despite historically low rates. Published data have consisted largely of small case series, some spanning several years (Int Braz J Urol 2006; 32: 454-458, Pediatr Surg 2002; 37: 1343-1346, J Urol 1995; 153: 180-182).

Seeking to provide more informative data on the subject, Kokorowski and colleagues searched the Pediatric Health Information Systems (PHIS) database, which comprises 28 hospitals that contribute data on outpatient pediatric surgical services.

They identified pediatric patients who underwent one of three types of specific penile procedures during 2003 to 2009:

  • Revision circumcision
  • Primary circumcision
  • Lysis of penile adhesions

The analysis included 34,568 patients who underwent one of the targeted procedures. The total consisted of 5,632 revision circumcisions, 25,768 primary circumcisions, and 3,168 procedures for lysis of penile adhesions.

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