This study was approved by the Etical Comitee of the Brussels University Hospital (cf. infra "Attachment 1").
Data were extracted from the Electronic Medical Dossier of the Brussels University Hospital. This database contains information of all patients admitted in the Brussels University Hospital. All patients who had a circumcision in the Brussels University Hospital from 1/1/1994 to 31/12/2012 were listed, based on the code of circumcision (260945 K75). All boys who were younger than 16 years old during circumcision were selected.
Per patient the date of the circumcision, the age during circumcision (in years) and the indication to circumcise are noted. If there is no clear indication, the patient is still included in the study to analyze the number of circumcisions and the mean age during circumcision. To identify the indication for circumcision, the dossier of the patient is examined. The patient is never contacted. When the indication noted in the consultation report differs from the indication in the surgical report, the indication of the consultation report is used. 46 patients that were listed based on the code of circumcision, did not have a circumcision. 23 patients had an adhesiolysis and/or frenulotomy and/or preputioplasty. 12 patients had a correction of a buried penis, 3 patients had a hypospadias correction, 1 had an excision of a penile botryomycoma and 7 had other interventions. These cases were excluded from the study.
20 patients underwent a second circumcision. In 2 cases there was a re-phimosis of the circumcised foreskin and in 18 cases parents found the circumcision inadequate with a requirement of a repair (to much foreskin left, esthetically insufficient,…). The second circumcision was excluded from further analysis.
Some older files (from 1994 to 2000) were lost; only the code of circumcision, the date of the operation and the patient’s date of birth were noted. The protocol of the operation and the consultation reports were missing. As 1.89 % of the patients who had a code of circumcision, did not have a circumcison, 1.89% of the patients with a lost file were not taken into account in the analysis of the total number of circumcisions.
The indications for circumcision noted in the study are phimosis, (recurrent episodes of) balanoposthitis, parental request, (recurrent episodes of) urinary tract infections and other reasons. These other reasons are all medical indications and include cure of paraphimosis (3 cases) and traumas of the foreskin (6 cases). It is important to note that a phimosis, adherent prepuce and tight foreskin are not distinguished. They are all noted under the ‘phimosis’ code, bearing in mind that some of the patients have a pathologic phimosis and others have a healthy non-retractile foreskin. Parental request includes ritual circumcision and non-ritual circumcision.