Audit to assess compliance with paediatric foreskin conditions commissioing guidelines
BAUS ePoster online library. Rea W. 06/22/21; 319143; pCU-6
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Will Rea
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Abstract
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Introduction:
Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance.
Methods:
We assessed electronic health records for all paediatric patients (<17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis.
Results:
198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for 'non-retractile foreskin' and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%).
Conclusion:
In our series large number of foreskin procedures were carried out over a 12 month period with a minority for the only absolute indication of pathological phimosis. We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.
Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance.
Methods:
We assessed electronic health records for all paediatric patients (<17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis.
Results:
198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for 'non-retractile foreskin' and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%).
Conclusion:
In our series large number of foreskin procedures were carried out over a 12 month period with a minority for the only absolute indication of pathological phimosis. We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.
Introduction:
Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance.
Methods:
We assessed electronic health records for all paediatric patients (<17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis.
Results:
198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for 'non-retractile foreskin' and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%).
Conclusion:
In our series large number of foreskin procedures were carried out over a 12 month period with a minority for the only absolute indication of pathological phimosis. We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.
Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance.
Methods:
We assessed electronic health records for all paediatric patients (<17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis.
Results:
198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for 'non-retractile foreskin' and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%).
Conclusion:
In our series large number of foreskin procedures were carried out over a 12 month period with a minority for the only absolute indication of pathological phimosis. We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.
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