title: [Nonretractable foreskin in boys without complaints : An indication for circumcision?]
abstract: BACKGROUND
  Removing boys' foreskins, even for medical reasons, is increasingly and critically discussed. The aim of this study is to retrospectively verify if the indication for the removal of boys' foreskins was justified. The study is based on the records of boys who underwent preputial operation in an outpatient medical office for pediatric surgery.
  
  
  METHODS
  Preoperative clinical findings, complaints, applied conservative and/or surgical procedures and histological results of the resected foreskins of boys, who underwent preputial operation between 2013-2015, were retrospectively analyzed.
  
  
  RESULTS
  A total of 176 boys (age 5 on average) underwent a preputial operation. In 85 % of the cases it was completely removed. Most frequent clinical findings (80 %) were that the prepuce was simply not retractable. 86 % of the boys were free of complaints. The most frequent histological findings were a discrete to moderately pronounced chronic fibrous posthitis (69 %) and subepithelial fibrosis (18 %), In the first case 78 % of the boys had been free of complaints, in the latter 72 %.
  
  
  CONCLUSIONS
  The majority of the treated boys were free of complaints; however, most of them underwent a complete removal of their foreskin simply because it was nonretractable. The foreskin represents the most sensitive part of the male genital, preputiolysis is a natural process that can go on until early adolescence. Irreversible surgical procedures, such as a complete foreskin removal, should thus be restricted to a clear medical indication.
authors.affiliation: Klinik für Kinderchirurgie, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Deutschland. kolja.eckert@icloud.com.
authors.forename: K
authors.initials: K
authors.lastname: Eckert
authors.affiliation: Praxis für Kinderchirurgie, Essen, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Janssen
authors.affiliation: Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinik, Düsseldorf, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Franz
authors.affiliation: Klinik für Kinderchirurgie, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Liedgens
mesh_terms: D058070:Asymptomatic Diseases / Q000453:epidemiology / Q000628:therapy; D002675:Child, Preschool; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making / Q000379:methods; D059026:Diagnostic Self Evaluation; D052816:Foreskin / Q000601:surgery*; D006801:Humans; D008297:Male; D018579:Patient Selection; D018802:Patient-Centered Care / Q000379:methods*; D010688:Phimosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Circumcision; Foreskin; Foreskin removal; Phimosis; Prepuce