Boksh Khalis, Patwardhan Nitin
Department of Paediatric Surgery, University Hospitals Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
JRSM Open. 2017 Jun 5;8(6):2054270417692731. doi: 10.1177/2054270417692731. eCollection 2017 Jun.
We observed whether general practitioners are referring more appropriately for balanitis xerotica obliterans in regards to circumcision, especially at a time of clinical concern, and whether their discriminative abilities were affected by age. We also aimed to explore if balanitis xerotica obliterans was over-diagnosed by surgeons potentially leading to unnecessary circumcisions of healthy foreskins.
Cross-sectional descriptive study.
Leicester Royal Infirmary.
All children less than 16 years of age were included and were subsequently split into two categories: those less than or equal to five years and those above five years. Circumcision was justified if surgeon found pathology under foreskin commissioning guidelines set by the Royal College of Surgeons of England. After clinical diagnosis of balanitis xerotica obliterans, the pathological database was searched for histological confirmation.
Has diagnostic accuracy improved amongst general practitioners for balanitis xerotica obliterans and is there a high clinical to histological confirmation.
Of the total patients, 14.5% were diagnosed clinically with balanitis xerotica obliterans. Only 66.7% of cases were histologically confirmed with chronic inflammation found in the rest; 5.5% of all boys referred had balanitis xerotica obliterans on histology; and 8.2% of children <5 had clinical balanitis xerotica obliterans with 1.7% confirmed histologically. This was in contrast with 18.1% and 9.2% found in the older cohort.
There remains a high diagnostic inaccuracy amongst general practitioners when referring for balanitis xerotica obliterans. This is greatest in those under five years. Although balanitis xerotica obliterans was over-diagnosed, no healthy foreskin underwent unnecessary circumcision.
我们观察了全科医生在包茎环切术方面，对于闭塞性干燥性龟头炎的转诊是否更恰当，尤其是在临床关注期，以及他们的鉴别能力是否受年龄影响。我们还旨在探讨闭塞性干燥性龟头炎是否被外科医生过度诊断，从而可能导致对健康包皮进行不必要的环切术。
横断面描述性研究。
莱斯特皇家医院。
纳入所有16岁以下儿童，随后分为两类：5岁及以下儿童和5岁以上儿童。如果外科医生根据英国皇家外科医学院制定的包皮环切术指南发现病理情况，则进行包皮环切术是合理的。在临床诊断为闭塞性干燥性龟头炎后，检索病理数据库以进行组织学确认。
全科医生对闭塞性干燥性龟头炎的诊断准确性是否有所提高，以及临床诊断与组织学确认之间的一致性是否较高。
在所有患者中，14.5%临床诊断为闭塞性干燥性龟头炎。只有66.7%的病例经组织学确认，其余病例发现有慢性炎症；所有转诊男孩中5.5%经组织学诊断为闭塞性干燥性龟头炎；5岁以下儿童中有8.2%临床诊断为闭塞性干燥性龟头炎，其中1.7%经组织学确认。相比之下，在年龄较大的队列中这一比例分别为18.1%和9.2%。
全科医生在转诊闭塞性干燥性龟头炎患者时，诊断不准确的情况仍然很严重。在5岁以下儿童中最为明显。虽然闭塞性干燥性龟头炎被过度诊断，但没有健康的包皮接受不必要的环切术。
