Abstract
Background/purposeCircumcisions are among the most frequent operations in children. Health service data on circumcision in the United States has documented an increase in neonatal circumcisions since 2012. We investigated whether a similar effect could be found in Germany, which does not endorse neonatal circumcision.MethodsWe analysed German routine administrative data for operations conducted on the preputium in order to analyse the frequency, age distribution, and time-trends in hospital-based procedures on a nationwide basis.ResultsThere were 9418 [95% confidence interval (CI) 8860–10,029] procedures per year, of which 4977 (95% CI 4676–5337) were circumcisions. Age distributions were highly different between both circumcisions (van der Waerden’s χ² = 58.744, df = 4, P < 0.0001) and preputium-preserving operations (van der Waerden’s χ² = 58.481, df = 4, P < 0.0001). Circumcisions were more frequent in the first 5 years of life and above 15 years of age, whereas preputium-preserving procedures were preferred in the age groups between 5 and 14 years of age. The number of circumcisions and preputium-preserving operations decreased in absolute and relative numbers.ConclusionsThe increasing trend towards neonatal circumcision observed in the United States is absent in Germany. The majority of patients were operated after the first year of life and absolute and relative numbers of hospital-based procedures were decreasing. Other factors such as increasing use of steroids for the preferred non-operative treatment of phimosis may play a role. As operations in outpatients and office-based procedures were not covered, additional research is necessary to obtain a detailed picture of circumcision and its surgical alternatives in Germany.Level of evidenceIII.
Highlights
Circumcision beyond infancy is among the most frequent paediatric surgical operations in countries that do not encourage neonatal circumcision [1], contrary to those who do [2]
We found relevant differences in the distribution of cases among the age groups for both circumcisions and for the preputium-preserving operations
The comparison of relative shares of circumcisions and preputium-preserving operations between the age groups revealed that circumcision was more frequent in Statistical analysis Statistical analysis was conducted in R [7] with its generic stats4-package unless indicated otherwise
Summary
Circumcision beyond infancy is among the most frequent paediatric surgical operations in countries that do not encourage neonatal circumcision [1], contrary to those who do [2]. The current situation of circumcision in the United States has been described by an increasing proportion of neonates who underwent. Oetzmann von Sochaczewski et al BMC Urol (2021) 21:34 or its preputium-preserving alternatives irrespective of the operating department in order to report data for a country that does not endorse neonatal circumcision
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