Pediatric Referrals for Nonreligious Circumcision: Trends at a Tertiary Center in North India

A BSTRACT Background: Do all Paediatric referrals for circumcision end up in surgery? An analysis would reveal the nature and the proportion of cases that need surgery. Objectives: To determine the proportion of cases requiring surgery among all referrals for circumcision by physicians. Methods: A retrospective study was conducted on all referrals for circumcision by physicians to the Department of Paediatric Surgery at a tertiary care hospital from July 2021 to June 2023. Patients were examined for their symptoms and classified into having physiological preputial adhesions, pathological phimosis, or any other local pathology. The first group either needed no intervention or benefitted from local adhesiolysis; those in the latter two groups were circumcised. All patients were followed up and their data were analyzed. Results: Of the 161 referrals for circumcision, 82.99% of patients had physiological preputial adhesions who improved either with observation alone (26.51%) when asymptomatic or simple adhesiolysis (68.94%) when symptomatic. Only six patients (4.54%) in this group needed circumcision. 10.56% of cases had pathological phimosis, of which 58.82% of cases had balanitis xerotica obliterans. These patients and those having local preputial pathologies (2.48%—preputial cyst, paraphimosis, or residual hemangioma) or vesicoureteral reflux (4.97%) underwent circumcision. Among all preputial adhesion and phimosis patients, only 15.44% of cases needed circumcision. Interpretation: Physiological preputial adhesions outnumbered pathological phimosis cases. However, circumcision was needed in the latter group, in the former simple adhesiolysis or conservative management sufficed. Proper diagnosis prevented unnecessary surgical intervention under anesthesia. Physicians need to be made aware of these two different entities.