Cambio de paradigma en el tratamiento quirúrgico de la fimosis en edad pediátrica. ¿Se ajusta la práctica a las recomendaciones actuales?

Abstract

Introduction

Improving the quality of care is a fundamental issue in medicine. The analysis of routine practice and its adequacy to the available evidence can detect areas for improvement. We have decided to apply these principles to the surgical treatment of phimosis in pediatric age. The aim of this study is to analyze the situation of phimosis surgery for children up to 18 years of age in our environment and its compliance with current recommendations.

Material and methods

Retrospective descriptive observational study including surgeries performed for phimosis in children and adolescents up to 18 years of age in 2022 and 2023. Data were compared with the recommendations of the European and British Pediatric Urology Associations.

Results

A total of 222 medical records were included. All surgeries were performed on an outpatient basis and with loco-regional anesthesia. The percentage of pathological phimosis was 11%. Among physiological phimosis, 47% were asymptomatic (70% between 3 and 7 years of age).

Discussion

According to current European recommendations, phimosis surgery is reserved for cases of symptomatic pathological or physiological phimosis or with increased risk of urinary tract infection. In pediatric patients in our environment, all aspects of phimosis surgery are performed according to current recommendations, but the percentage of asymptomatic phimosis operated on in young children is high. Based on the possibility of spontaneous resolution, the indication and optimal age of intervention in this group of patients should be reviewed.