TY - JOUR
T1 - Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease
T2 - Two nationwide register-based cohort studies in Denmark 1977-2013
AU - Frisch, Morten
AU - Simonsen, Jacob
N1 - Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background: Meatal stenosis is markedly more common in circumcised than genitally intact males, affecting 5–20 per cent of circumcised boys. However, no population-based study has estimated the relative risk of meatal stenosis and other urethral stricture diseases (USDs) or the population attributable fraction (AF
p) associated with non-therapeutic circumcision. Methods: In two nationwide cohort studies (comprising 4.0 million males of all ages and 810 719 non-Muslim males aged 0–36 years, respectively), we compared hospital contact rates for USD during 1977–2013 between circumcised and intact Danish males. Hazard ratios (HRs) were obtained using Cox proportional hazards regression, and the AF
p estimated the proportion of USD cases in <10 year-old boys that is due to non-therapeutic circumcision. Results: Muslim males had higher rates of meatal stenosis than ethnic Danish males, particularly in <10 year-old boys (HR 3.44, 95 per cent confidence interval 2.42–4.88). HRs linking circumcision to meatal stenosis (10.3, 4.53–23.4) or other USDs (5.14, 3.48–7.60) were high, and attempts to reduce potential misclassification and confounding further strengthened the association, particularly in <10 year-old boys (meatal stenosis: 26.3, 9.37–73.9; other USDs: 14.0, 6.86–28.6). Conservative calculations revealed that at least 18, 41, 78, and 81 per cent of USD cases in <10 year-old boys from countries with circumcision prevalences as in Denmark, the United Kingdom, the United States and Israel, respectively, may be attributable to non-therapeutic circumcision. Conclusion: Our study provides population-based epidemiological evidence that circumcision removes the natural protection against meatal stenosis and, possibly, other USDs as well.
AB - Background: Meatal stenosis is markedly more common in circumcised than genitally intact males, affecting 5–20 per cent of circumcised boys. However, no population-based study has estimated the relative risk of meatal stenosis and other urethral stricture diseases (USDs) or the population attributable fraction (AF
p) associated with non-therapeutic circumcision. Methods: In two nationwide cohort studies (comprising 4.0 million males of all ages and 810 719 non-Muslim males aged 0–36 years, respectively), we compared hospital contact rates for USD during 1977–2013 between circumcised and intact Danish males. Hazard ratios (HRs) were obtained using Cox proportional hazards regression, and the AF
p estimated the proportion of USD cases in <10 year-old boys that is due to non-therapeutic circumcision. Results: Muslim males had higher rates of meatal stenosis than ethnic Danish males, particularly in <10 year-old boys (HR 3.44, 95 per cent confidence interval 2.42–4.88). HRs linking circumcision to meatal stenosis (10.3, 4.53–23.4) or other USDs (5.14, 3.48–7.60) were high, and attempts to reduce potential misclassification and confounding further strengthened the association, particularly in <10 year-old boys (meatal stenosis: 26.3, 9.37–73.9; other USDs: 14.0, 6.86–28.6). Conservative calculations revealed that at least 18, 41, 78, and 81 per cent of USD cases in <10 year-old boys from countries with circumcision prevalences as in Denmark, the United Kingdom, the United States and Israel, respectively, may be attributable to non-therapeutic circumcision. Conclusion: Our study provides population-based epidemiological evidence that circumcision removes the natural protection against meatal stenosis and, possibly, other USDs as well.
KW - Circumcision
KW - Complications
KW - Epidemiology
KW - Meatal stenosis
KW - Urethral stricture disease
KW - Constriction, Pathologic/etiology
KW - Humans
KW - Child, Preschool
KW - Infant
KW - Male
KW - Risk
KW - Circumcision, Male/adverse effects
KW - Young Adult
KW - Denmark/epidemiology
KW - Islam
KW - Adolescent
KW - Adult
KW - Registries
KW - Urethral Stricture/etiology
KW - Child
KW - Culture
KW - Infant, Newborn
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85010737730&partnerID=8YFLogxK
U2 - 10.1016/j.surge.2016.11.002
DO - 10.1016/j.surge.2016.11.002
M3 - Journal article
C2 - 28017691
SN - 1479-666X
VL - 16
SP - 107
EP - 118
JO - The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
JF - The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
IS - 2
ER -