[Development of circumcision rates in Germany since the approval of ritual circumcision : A population-based analysis from 2013 to 2018]

INTRODUCTION

The religious and cultural circumcision of male infants in Germany is controversially discussed. After the passing of the religious circumcision bill in 2012, an increase of infant circumcisions without medical indication was feared. The aim of this study was to analyze the development of the circumcision case numbers.

MATERIALS AND METHODS

We used the research database of the German Institute for Applied Health Research with a representative anonymous sample of 4.9 million insured persons to estimate the annual circumcision numbers in Germany from 2013-2018. We stratified the data according to age (< 18 vs. ≥ 18 years). The number of male adolescents in the study period was taken from the database of the German Federal Statistical Office.

RESULTS

In the study period, 673,819 circumcisions were performed. From 2014, there was a significant decrease in the number of cases across all age groups (p = 0.049). Thereby, circumcisions in minors significantly increased (p = 0.002) and procedures in adults significantly decreased (p = 0.01) during the entire study period. The number of male minors increased by 4% from 6,709,137 (2013) to 6,992,943 (2018). The corresponding population-based number increased from 7.5 circumcisions per 1000 minors in 2013 to 8 in 2018 (p = 0.037).

CONCLUSIONS

After the passage of the circumcision bill in 2012, there was a significant increase of circumcisions in the age group of < 18 years in Germany. A major limitation of our study is that presumably many ritual circumcisions might not be provided within the health care system.

[Application of disposable oval circumcision anastomat in pediatric urology]

Objective: To summarize the application experience of Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat in pediatric urology. Methods: A retrospective study of 1 481 cases of pediatric urology using a disposable oval circumcision anastomat at Xuzhou Children's Hospital from October 2014 to December 2017 was performed. The average age at the time of surgery was 5.2 (2-14 years) years. Among them, there were 1 226 cases of phimosis, 32 cases of scar phimosis in chronic infection, 23 cases of phimosis or redundant prepuce with urethral duplication, 29 cases of foreskin trauma, 35 cases of phimosis or redundant prepuce with urethral cyst, 3 cases of phimosis or redundant prepuce with urethral stricture, 108 cases of phimosis or redundant prepuce with webbed penis, 6 cases of phimosis with penile downward bending, 4 cases of phimosis with short frenulum preputii, and 15 cases of relatively normal foreskin development, I° and II° hypospadias with unapparent penile downward bending, and megalourethra with complete foreskin hypospadias. Results: All operations were completed successfully. The postoperative circumcision time was less than 5 days on 2 cases(0.1%), and was longer than 25 days on 9 cases(0.6%). The average postoperative circumcision time was 13.2 days. During a follow-up period of 3 months, except for 2 cases (0.1%) of frenulum preputii edema, all other cases had a satisfactory foreskin appearance. They had no obvious foreskin scar hyperplasia, the foreskin cutting edge was neat, the foreskin ligament was intact, the foreskin was left and right symmetrical, and the foreskin was preserved in the absence of erection to cover the coronary sulcus to 1/3 of the glans. All children with hypospadias had no urethral stricture and urethral fistula, and the penis was satisfactory. Conclusions: Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat is satisfactory in the treatment of various diseases of pediatric urology. With a low incidence of postoperative complications, it may be easy to carry out this procedure at grass-roots hospital.

[The impact of male circumcision on the natural history of genital HPV infection: a prospective cohort study]

Objective: To analyze the correlation between circumcision and incidence and clearance of male genital HPV infection. Methods: From May to July 2014, 18-55 year old men who had sexual behavior history were recruited from the general population in Liuzhou, Guangxi to set up a cohort. Totally, 113 circumcised and 560 uncircumcised men were enrolled and interviewed using a questionnaire (including information on demographic characteristics and sexual behaviors), then they were followed-up with 6-month interval for 2 times. On each visit, specimens of male external genitalia were collected and genotyped for HPV DNA. The differences of incidence and clearance of genital HPV infections between circumcised and uncircumcised men were analyzed by Log-rank test. Cox regression was used to analyze the relationship between circumcision and incidence and clearance of HPV infection. Results: The median age (P(25), P(75)) of circumcised and uncircumcised men were 28 (24, 35) and 32 (24, 31), respectively. The incidences of any HPV infections were 9.1 (95%CI: 2.4-15.7) and 8.4 (95% CI: 5.6-11.2) per 1 000 person-months (χ(2)=0.10, P=0.758), respectively. The clearance of circumcised men [136.3 (95%CI: 70.0-202.7) per 1 000 person-months] was higher than that in uncircumcised men [89.6 (95%CI: 65.9-113.3) per 1 000 person-months] (χ(2)=8.19, P=0.004). In multivariate COX regression analysis, compared with uncircumcised men, circumcised men had higher possibility to clear any HPV infections (HR: 2.41, 95%CI: 1.30-4.46). Compared with men having one sexual partner, people having more than 4 sexual partners had lower possibility to clear any HPV infections (HR: 0.49, 95%CI: 0.25-0.96). Compared with 18-25 years old men, men aged 26-35 years old had higher possibility to clear high-risk HPV infections (HR: 2.14, 95%CI: 1.08-4.23). Conclusion: Circumcised and uncircumcised men had similar incidence of genital HPV infection, whereas, men conducted circumcision and having fewer sexual partners could increase the clearance of genital HPV infections.

[Impact of organ sparing therapy in penile carcinoma on sexual and erectile function]

INTRODUCTION

Penile carcinoma is one of the less frequent tumors of the genitourinary system, however its effect on the patients' sex life and quality of life is of great impact. Studies about the influence on patients' sex life are scarce.

OBJECTIVES

To characterize sexual activity with penetration of patients with penile carcinoma who underwent different conservative therapeutic approaches and to evaluate pre and post treatment erectile function. Secondarily, to compare the results between the patients who underwent partial penectomy to those subjected to other conservative therapies.

MATERIAL AND METHODS

Review of patients' records diagnosed with penile carcinoma and observed at the Portuguese Institute of Oncology of Oporto between 2005 and 2015, to obtain demographic, clinical and histopathological data. Telephone interviews for the completion of the International Index of Erectile Function-5 (IIEF-5) questionnaire to patients undergoing treatment in that period.

RESULTS

16 out of the 107 patients met the inclusion criteria (n=16), with an average IIEF-5 score of 23.44 (10-25), lowering this value to 16.56 (5-25) after therapy, p<0,05. Fifteen out of the 16 patients kept sexual activity (93.8%) and one (6.25%) suspended due to erectile dysfunction. IIEF-5 score after treatment in the subgroup that underwent partial penectomy was lower when compared to the other subgroup of patients subjected to others conservative therapies, without statistical significance.

CONCLUSION

Although penile carcinoma treatment has an impact in erectile function with statistical significance, the majority of patients keeps an active sexual life with penetration after treatment. It's not possible to conclude that less invasive therapies are associated with better erectile function.