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April 2018Volume 16, Issue 2, Pages 107–118
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Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977–2013

Morten Frisch
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Morten Frisch
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Affiliations

  • Statens Serum Institut, Department of Epidemiology Research, DK-2300 Copenhagen S, Denmark
  • Aalborg University, Department of Clinical Medicine, Center for Sexology Research, DK-9000 Aalborg, Denmark

Correspondence

  • Corresponding author. Department of Epidemiology Research, Division of Epidemiology and Disease Surveillance, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark.
'Correspondence information about the author Morten Frisch
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Morten Frisch
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Affiliations

  • Statens Serum Institut, Department of Epidemiology Research, DK-2300 Copenhagen S, Denmark
  • Aalborg University, Department of Clinical Medicine, Center for Sexology Research, DK-9000 Aalborg, Denmark

Correspondence

  • Corresponding author. Department of Epidemiology Research, Division of Epidemiology and Disease Surveillance, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark.
,
Jacob Simonsen
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Jacob Simonsen
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Affiliations

  • Statens Serum Institut, Department of Epidemiology Research, DK-2300 Copenhagen S, Denmark
Published Online: December 22, 2016
Open AccessCultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977–2013
DOI: https://doi.org/10.1016/j.surge.2016.11.002
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Abstract

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 (AFp) 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 AFp 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.

Keywords:

Circumcision, Complications, Epidemiology, Meatal stenosis, Urethral stricture disease
© 2016 The Author(s). Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
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April 2018Volume 16, Issue 2, Pages 107–118