Analysis of referrals for phimosis to specialist care: What happens next?

Introduction: referrals for pediatric surgery consultation due to phimosis are relatively common. They generate a significant volume of patients that need to be seen at the hospital. As the current approach to the management of physiological asymptomatic phimosis is conservative, we set out to analyze the characteristics of these referrals and their outcomes. Methods: we reviewed a random sample of referrals to pediatric surgery consultation for phimosis between 2019 and 2022. We analyzed patient characteristics, the reasons for referral and the outcomes of the consultation. Results: the sample included a total of 392 referrals. The mean patient age was 5.8 years. Of this total, 40.6% were 4 years old or younger at the time of referral. Seventy-nine percent of de cases were asymptomatic. Twenty-four patients (6.2%) received a diagnosis of lichen sclerosus (balanitis xerotica obliterans). Surgery was the approach selected in the initial visit in only 25% of the cases. Discharge or follow-up without active treatment were significantly more likely in children aged less than 6 years. Conclusions: most children referred to pediatric surgery during the study period had asymptomatic physiological phimosis, and surgery was the selected approach in the initial consultation in only a quarter of them. In order to optimize resources and in adherence to current guidelines, we propose improving the education of families and health care professionals, ensuring adequate healthy foreskin care and conservative management of phimosis and limiting referrals for symptomatic cases or those that do not respond to conservative treatment.