Trends in pediatric circumcision in Belgium and the Brussels University Hospital from


Year Brussels Capital Region



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Year

Brussels Capital Region

Flemish Brabant

Total

1994

85,152

87,873

173,025

1996

85,247

88,357

173,604

1998

86,048

88,261

174,309

2000

87,665

88,597

176,262

2002

90,790

89,156

179,946

2004

93,159

89,619

182,778

2006

96,039

90,297

186,336

2008

99,679

91,142

190,821

2010

104,240

92,363

196,603

2012

112,367

94,379

206,746

Table 1 Number of boys aged 0 to 15 years living in the Brussels Capital Region and Flemish Brabant over the 19-year study period
From 1994 to 1999 the number of circumcisions performed in the Brussels University Hospital remained relatively stable. In this period, the number of boys aged 0 to 15 years living in Brussels and Flemish Brabant increased. There was a drop in the number of circumcisions performed in the Brussels University Hospital in the years 2000 and 2005. From 2002 on, the number of circumcisions performed in the Brussels University Hospital steadily increased (2005 not included).

Figure 2 Number of pediatric circumcisions compared to the number of boys aged 0 to 15 years living in the Brussels Capital Region and Flemish Brabant over the 19-year study period


72.90% of all pediatric circumcisions in the study interval were performed in boys aged less than 5 years, 20.68% in boys aged 5 to 9 years and 6.43% in boys aged 10 to 15 years. The number of circumcisions of boys aged less than 5 years doubled over the study period, from 120.00 in 1994 to 243.00 in 2012. In boys aged between 5 and 9 years, the number of circumcisions decreased by 22.80%, from an average of 47.80 in 1994-2003 to an average of 36.90 in 2003-2012. In boys aged between 10 and 15 years, the number of circumcisions remained relatively stable.

Figure 3 Number of pediatric circumcisions over time according to age


The mean age of the boys who underwent a circumcision during the study interval was 3.6 years. This age declined by about 38.67%, from 4.50 years in 1994 to 2.76 in 2012. The median age that boys were circumcised during the study period was 3 years. The number declined by 50%, from the age of 4 in 1994 to the age of 2 in 2012.

Figure 4 Mean age and median age of circumcised boys over time


The indication for circumcision was documented in 3400 of the 3937 boys included in the study. In boys with a known indication, a total of 44.12% underwent a circumcision for phimosis, 52.31% for parental request, 1.91% for balanoposthitis (recurrent and non-recurrent), 1.36% for urinary tract infections (recurrent and non-recurrent) and 0.30% for other reasons. Over the 19-year interval, the number of circumcisions for phimosis fell by 58.14 % from 133.77 cases in 1994 to 56.00 in 2012. The decrease in the number of circumcisions to treat phimosis is substantial between 1999 and 2002. The number decreased by 61.49%, from 142.97 in 1999 to 55.05 in 2002. From 2002 on, this number remained relatively stable. However, because of a rise in the circumcisions performed for parental whish, a decreasing percentage of boys are circumcised to treat phimosis. The number of circumcisions performed for balanoposthitis and for urinary tract infections remained relatively stable. The number of circumcisions performed for parental request increased by 382.85% from 48.88 in 1994 to 236.00 in 2012. Parental request includes ritual circumcision and non-ritual circumcision. The parental motive for requesting circumcision for their son was not specified in the medical files. From 1994 to 2000, the number of circumcisions performed for parental request remained relatively stable at an average of 45.13 circumcisions per year. From 2000 on, this number increased by 372.05%, from 50.00 in 2000 to 236.00 in 2012.

Figure 5 Indications for pediatric circumcision over time (absolute number)


Figure 6 Indications for pediatric circumcision over time (percentage)


When the indications to circumcise are stratified by age group, there is over a five-fold increase in the number of circumcisions performed for parental request in the group of 0 to 4 year old boys, from 32.31 in 1994 to 206.00 in 2012. The number of circumcisions performed for phimosis in this age group decreased by 63.89%, from 83.08 in 1994 to 30.00 in 2012. This decrease is substantial between 1999 and 2001. The number of circumcisions performed for phimosis in 0 to 4 year old boys decreased by 53.03%, from 93.88 in 1999 to 44.09 in 2001.

Figure 7 Indications to circumcise over time in boys aged 0 to 4 years old (absolute number)


In 5 to 9 year olds and 10 to 15 year olds, the number of circumcisions performed for medical indications (M I) decreased by about respectively 38.94% and 36.57%, from an average of 36.18 and 10.80 in 1994-2003 to an average of 22.09 and 6.85 in 2003-2012. These medical indications include phimosis, balanoposthitis, urinary tract infections and other reasons. The number of circumcisions performed for parental request (P R) increased by about 27.43% in 5 to 9 year olds, from an average of 11.62 in 1994-2003 to an average of 14.81 in 2003-2012. The number of circumcisions performed for parental request remained relatively stable in 10 to 15 year olds at an average of 4.40 circumcisions per year.

Figure 8 Indications to circumcise stratified by age group over time (absolute number)





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