The distribution of the clinical variables in a population of adult males circumcised for phimosis: A contribution to the clinical classification of phimosis

Submitted: April 13, 2022
Accepted: May 3, 2022
Published: June 30, 2022
Abstract Views: 851
PDF: 550
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Background: The literature regarding the quality of the sex life in adult males after circumcision, due to phimosis, is scarce and sometimes contrasting. This could be due to comparisons of a nonhomogeneous distribution of the clinical variables of men who have undergone circumcision. Objective: The objective of this study was to evaluate the distribution of the clinical variables in the adult male population who had circumcision for phimosis, and to propose a clinical classification of the phimosis to characterize it in adult males in more homogeneous sub-groups for the common clinical variables. Materials: A population of 244 adult male patients with phimosis was evaluated retrospectively. The mean age was 50.7 years. Each patient was classified according to the most common clinical variables. The variables that make up this classification of the phimosis were: Position (P1-2) to indicate if phimosis is present when the penis is at rest (P2) or only during an erection (P1); Grade (G 0-4) in relation to the extent of glans visibility; Complexity (Co 0-4) of comorbidities; Timespan (T 1-10) of the phimosis. Results: The distribution of the variables was the following: Position P1:30.73%, P2:69.26%; Grade G0:30.73%, G1:23.77%, G2:27.45%, G3:12.29%, G4:5.73%; Complexity (associated penile comorbidities): C0:48.36%, C1:4.5%, C2:0.8%, C3:43.03%, C4:3.27% Timespan: 57.78% of the patients had phimosis for less than a year; 18.03% between 1 and 2 years; 11.88% between 2 and 10 years; and 12.29% for more than 10 years. Conclusions: The distribution of the clinical variables in the adult male population who underwent circumcision due to phimosis was not homogeneous regarding the appearance, severity, comorbidity, and timespan. This non-homogeneity could explain, in some cases, the contrasting results regarding the quality of sex life after circumcision in the literature. The proposed classification can offer an objective tool for researchers and clinicians group the patients into more homogeneous subgroups.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Joint United Nation Programm on HIV/AIDS (UNAIDS) Neonatal and Child male circumcision: a global review 2010
Morris BJ, Krieger JN The contrasting evidence concerning the effect of male circumcision on sexual function, sensation and pleasure: a systematic review. Sex Med. 2020; 8:577-598. DOI: https://doi.org/10.1016/j.esxm.2020.08.011
Tian Y, Liu W, Wang JZ, et al. Effects of circumcision on male sexual functions: a systematic review and meta-analysis. Asian J Androl. 2013; 15:662-6. DOI: https://doi.org/10.1038/aja.2013.47
Perovic SV. Atlas of congenital anomalies of the external genitalia. Refot Arka. 1999: p.13
Bañuelos Marco B, García Heil JL Circumcision in childhood and male sexual function: a blessing or a curse? Int J Impot Res. 2021; 33:139-148. DOI: https://doi.org/10.1038/s41443-020-00354-y
Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity or satisfaction? A systematic review. J Sex Med. 2013; 10:2644-2657. DOI: https://doi.org/10.1111/jsm.12293
Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018; 178:839-853. DOI: https://doi.org/10.1111/bjd.16241
Kravvas G, Muneer A, Watchorn RE, et al. Male genital lichen sclerosus, microincontinence and occlusion: mapping the disease across the prepuce. Clin Exp Dermatol. 2022 Feb 12. doi: 10.1111/ced.15127. Epub ahead of print. PMID:35150005. DOI: https://doi.org/10.1111/ced.15127
Gkalonaki I, Anastasakis M, Psarrakou IS, Patoulias I. Balanitis Xerotica Obliterans: an underestimated cause of secondary phimosis. Folia Med Cracov. 2021; 61:93-100.
Paulis G, Berardesca E. Lichen sclerosus: the role of oxidative stress in the pathogenesis of the disease and its possible transformation into carcinoma. Res Rep Urol. 2019; 11:223-232. DOI: https://doi.org/10.2147/RRU.S205184
Edmonds EV, Hunt S, Hawkins D, et al. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol. 2012; 26:730-7. DOI: https://doi.org/10.1111/j.1468-3083.2011.04155.x
Kirikos CS, Beasley SW, Woodward AA. The response to phimosis to local steroid application. Pediatric Surg Intern. 1993; 8:329-332. DOI: https://doi.org/10.1007/BF00173357
La Pera G, De Luca F, Guerani A, et al. Prevalence of phimosis and foreskin sliding abnormalities in male adolescents and their correlation with later onset of first sexual intercourse. Arch Ital Urol Androl. 2017; 89:310-312. DOI: https://doi.org/10.4081/aiua.2017.4.310
Schöeder A. Circumcision: case against surgery without medical indication in DA Bolnick, M Koyle, A Yosha (Eds) Surgical guide to circumcision, Springer 2012; pp 185-186. DOI: https://doi.org/10.1007/978-1-4471-2858-8_16
Perovic SV. Atlas of congenital anomalies of the external genitalia, Refot Arka. 1999; 13.
Czajkowski M, Czajkowska K, Zaranska K, et al. Male circumcision due to phimosis as the procedure that is not only relieving clinical symptoms of phimosis but also improves the quality of sexual life. Sex Med. 2021; 9:100315. DOI: https://doi.org/10.1016/j.esxm.2020.100315
Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control 2011; 22:1097-1110. DOI: https://doi.org/10.1007/s10552-011-9785-9
Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol. 2006; 54:369-391. DOI: https://doi.org/10.1016/j.jaad.2005.05.007
Kochen M, McCurdy S. Circumcision and the risk of cancer of the penis. A life-table analysis. Am J Dis Child. 1980; 134:484-6. DOI: https://doi.org/10.1001/archpedi.1980.02130170034012
Wiswell T, Circumcision Circumspection. N Engl J Med. 1997; 336:1244-5. DOI: https://doi.org/10.1056/NEJM199704243361709
Wiswell TE. Neonatal circumcision: a current appraisal Focus Opin Pediat 1995; 1:93-99.
Tsen HF, Morgenstern H, Mack T, Peters RK. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (US). Cancer Causes Control. 2001; 12:267-277. DOI: https://doi.org/10.1023/A:1011266405062
Vieira CB, Feitoza L, Pinho J, et al. Profile of patients with penile cancer in the region with the highest worldwide incidence. Sci Rep. 2020; 10:2965. DOI: https://doi.org/10.1038/s41598-020-59831-5
Vieira CB, Teixeira-Júnior A, Feitoza L, et al. A cohort study among 402 patients with penile cancer in Maranhao, Northeast Brazil with the highest worldwide incidence BMC Res Notes. 2020; 13:442. DOI: https://doi.org/10.1186/s13104-020-05283-z
Nakata S, Imai K, Yamanaka H. Study of risk factors for prostatic cancer. Hinyokika Kiyo. 1993; 39:1017-24.
Kupferschmid C. Commentary on "Countries with high circumcision prevalence have lower prostate cancer mortality". Asian J Androl. 2016; 18:949.
Wachtel MS, Shengping Yang S, Morris BJ. Countries with high circumcision prevalence have lower prostate cancer mortality Asian J Androl. 2016; 18:39-42. DOI: https://doi.org/10.4103/1008-682X.159713
Morris BJ, Waskett JH. Circumcision reduces prostate cancer risk. Asian J Androl. 2012; 14:661-2. DOI: https://doi.org/10.1038/aja.2012.47

How to Cite

La Pera, G., & Lauretti, S. (2022). The distribution of the clinical variables in a population of adult males circumcised for phimosis: A contribution to the clinical classification of phimosis. Archivio Italiano Di Urologia E Andrologia, 94(2), 222–227. https://doi.org/10.4081/aiua.2022.2.222