Response to Letter to the Editor regarding: Referrals from Primary Care with Foreskin Symptoms: Is there Really Room for Improvement?

In their letter, Cox and Morris advocate for childhood circumcision and imply that our article aims to prevent boys undergoing the procedure [ [1] Cox G. Morris B.J. Letter to editor regarding: referrals from primary care with foreskin symptoms: is there really room for improvement?. J Pediatr Surg. 2022; https://doi.org/10.1016/j.jpedsurg.2022.12.012 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. As UK based practitioners where a large proportion of males have a foreskin, we follow the guidance given in the ‘Foreskin Conditions Commissioning Guide’ published by the Royal College of Surgeons of England in 2013 (revised 2016) [ [2] Foreskin Conditions Commissioning guide 2016: Sponsoring Organisation: British Associations of Urological Surgeons/British Associations of Paediatric Surgeons/British Associations of Paediatric Urologists. https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/nscc/revised-foreskin-conditions-commissioning-guide-republished.pdf?la=en. Google Scholar ] and the Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists ‘Management of Foreskin Conditions’ [ [3] Management Of Foreskin Conditions. Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists. http://www.baps.org.uk/content/uploads/2017/03/MANAGEMENT-OF-FORESKIN-CONDITIONS.pdf. Google Scholar ]. The indications for circumcision in the guidance include penile malignancy, traumatic foreskin injury where it cannot be salvaged, Balanitis Xerotica Obliterans, severe recurrent attacks of balanoposthitis and recurrent febrile UTI's with an abnormal urinary tract [ [3] Management Of Foreskin Conditions. Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists. http://www.baps.org.uk/content/uploads/2017/03/MANAGEMENT-OF-FORESKIN-CONDITIONS.pdf. Google Scholar ]. Therefore, like the population of Canada and much of Europe, many boys in the UK ‘are likely to live out their lives with an intact prepuce’ and understanding what is normal and when intervention has greater benefit than risk is vital [ [4] Abara E.O. Prepuce health and childhood circumcision: choices in Canada. Can Urol Assoc J. 2017; 11: S55-S62 Crossref PubMed Scopus (9) Google Scholar ].