Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA; Surgical Population Analysis Research Core, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
J Pediatr Surg. 2024 Nov;59(11):161614. doi: 10.1016/j.jpedsurg.2024.06.022. Epub 2024 Jul 5.
To compare penile problems in circumcised relative to uncircumcised boys, and to determine which providers performing the circumcision have fewer post-circumcision problems.
CPT codes in the 2011-2020 MarketScan database were used to identify boys who had a circumcision. Uncircumcised control subjects of the same age, state of residence, and insurance type were selected. The primary outcome was a penile problem, defined as penis-specific infection, inflammation, and urethral stricture/stenosis, among others. The secondary outcomes were procedure-related complications limited to 28 days after circumcision, and whether post-circumcision problems varied by the clinician performing the procedure. ICD-9/10 diagnostic codes were used to identify these problems.
We identified ∼850,000 cases and ∼850,000 matched controls. Overall, the rate of penile problems within the first five years of life was 1.7% in circumcised boys versus 0.5% in uncircumcised boys (p < 0.05). Multivariable regression models showed that the risk of penile problems was 2.9-fold higher among circumcised compared to uncircumcised males (95%CI [2.8-3], p < 0.001). Compared to males circumcised by pediatricians, those circumcised by surgeons had 2.1-fold higher penile problems in the year after circumcision (95% CI [2-2.3], p < 0.001). Procedure-related complications within 28 days of circumcision were infrequent (0.5%), with the most common being penile edema (0.2%).
Penile problems are very infrequent in boys in the first five years of life. However, when they occur, they are 3x more likely to occur in circumcised boys relative to uncircumcised boys. Penile problems are more likely to occur in boys circumcised by surgeons.
Level II.
Prognosis study.
比较包皮环切术与未行包皮环切术男孩的阴茎问题，并确定实施环切术的医生中术后出现问题的比例更低。
使用 2011 年至 2020 年 MarketScan 数据库中的 CPT 代码识别行包皮环切术的男孩。选择年龄、居住地和保险类型相同的未行包皮环切术的对照组。主要结局是阴茎问题，定义为阴茎特定的感染、炎症和尿道狭窄/梗阻等。次要结局是术后 28 天内与手术相关的并发症，以及行环切术的医生是否会导致术后问题存在差异。使用 ICD-9/10 诊断代码识别这些问题。
我们共确定了约 85 万例病例和 85 万例匹配的对照组。总体而言，在生命的头五年内，行包皮环切术的男孩中阴茎问题的发生率为 1.7%，而未行包皮环切术的男孩中为 0.5%（p<0.05）。多变量回归模型显示，与未行包皮环切术的男性相比，包皮环切术男性的阴茎问题风险高 2.9 倍（95%CI [2.8-3]，p<0.001）。与由儿科医生行包皮环切术的男性相比，由外科医生行包皮环切术的男性在术后第一年阴茎问题发生率高 2.1 倍（95%CI [2-2.3]，p<0.001）。术后 28 天内的与手术相关的并发症很少见（0.5%），最常见的是阴茎水肿（0.2%）。
在生命的头五年内，男孩中阴茎问题非常少见。然而，当发生时，与未行包皮环切术的男孩相比，行包皮环切术的男孩发生阴茎问题的可能性要高出 3 倍。由外科医生行包皮环切术的男孩更容易发生阴茎问题。
二级。
预后研究。
