Phimosis and Diabetes Mellitus

Phimosis and Diabetes Mellitus

Vol. 110, October Printed in U.S.A. THE JOURNAL OF UROLOGY Copyright© 1973 by The Williams & Wilkins Co. PHIMOSIS AND DIABETES MELLITUS JERRY L. CA...

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Vol. 110, October Printed in U.S.A.

THE JOURNAL OF UROLOGY

Copyright© 1973 by The Williams & Wilkins Co.

PHIMOSIS AND DIABETES MELLITUS JERRY L. CATES, ALBERT FINESTONE

AND

MORTON BOGASH

From the Departments of Urology and Medicine, Episcopal Hospital, Philadelphia and Pottstown Memorial Medical Center, Pottstown, Pennsylvania

We have been impressed with the frequent occurrence of previously undiagnosed diabetes mellitus in patients with recently acquired phimosis secondary to balanoposthitis. A search of the literature revealed 3 recent reports on this subject, with only 17 patients involved. 1 -• We decided to explore the relationship between phimosis and diabetes mellitus in a retrospective study. The records were studied of 156 patients more than 18 years old who underwent circumcision between 1968 and 1971. Patients were divided into 3 groups according to age: 18 to 34 years, 35 to 60 years and 61 years and older. The presence or absence of diabetes was noted. Patients were considered diabetic if they had diabetes which was being treated or if a diabetic glucose tolerance curve was present or fasting blood sugar was more than 120 mg. per cent. Diabetes was classified as either known or previously undiagnosed. The state of the prepuce was classified as no phimosis, long-standing phimosi:i or recent phimosis. Table 1 shows the expected incidence of diabetes in the general male population according to Public Health Service Statistics.• In the 110 patients with recently acquired phimosis, 9 had known diabetes and 26 had previously undiagnosed diabetes (table 2). Thus, 35 of 110 patients (31.8 per cent) with recently acquired phimosis had diabetes mellitus. This is significantly higher than the expected incidence of diabetes in the general male population. The low incidence of diabetes mellitus in the group with long-standing phimosis and in the group without phimosis is generally consistent with the incidence expected in the general male population. Patients with long-standing phimosis probably had the condition since birth. However, exact knowledge in this regard was not ascertainable (tables 3 and 4). Accepted for publication March 16, 1973. Read at annual meeting of Mid-Atlantic Section, American Urological Association, White Sulphur Springs, West Virginia, October 15-18, 1972. 1 Hershfi?ld, M. and Dahlen, C. P.: Phimosis with balanoposthitis in previously undiagnosed diabetes mellitus. GP, 38: 95, 1968. 2 Crowe, G. G.: Diabetes presenting with phimosis. Lancet, 2: 50, 1971. • Skoglund, R. W.: Diabetes presenting with phimosis. Lancet, 2: 1431, 1971. 'United States Public Health Service Publication: Characteristics of persons with diabetes, United StatesJuly 1964-June 1965. Washington, D.C.: United States Department of Health, Education and Welfare, no. 1000, series 10, no. 40, 1967. 406

Crowe stated that during a 20-year period he saw 8 men between 30 and 35 years old with a short history of phimosis who were previously free of symptoms. 2 All of his patients had diabetes melTABLE

1. Incidence of diabetes in the general male population Incidence of Diabetes(%)

Age (yrs.) <25 25 to 44 45 to 54 55 to 64 65 to 74

0.12 0.62 1.54 3.20 4.74

2. Phimosis-recent onset

TABLE

Total No. pts. No diabetes Diabetes Previously undiagnosed diabetes No. with diabetes(%)

TABLE

18to 34 Yrs.

35 to 60 Yrs.

>61 Yrs.

44 36 2 6

50 31 7 12

16

8 (18.1)

19 (38)

8 (50)

8 0 8

3. Phimosis-long-standing

Total No. pts. No diabetes Diabetes Previously undiagnosed diabetes No. with diabetes(%)

TABLE

Total No. pts. No diabetes Diabetes Previously undiagnosed diabetes No. with diabetes(%)

18 to 34 Yrs.

35 to 60 Yrs.

>61 Yrs.

10 9 0

6 6 0 0

6 5 1 0

1 (10)

0 (0)

1 (16.6)

4. Phimosis-none 18to 34 Yrs.

35 to 60 Yrs.

>61 Yrs.

14 14 0 0

6 6 0 0

3 0 1

0 (0)

0 (0)

1 (25)

4

litus and with its treatment the phimosis resolved spontaneously, making circumcision unnecessary. 2 Skoglund stated that in 2 of 3 somewhat similar cases circumcision was eventually necessary because of severe scarring. 3 All of our patients were circumcised. Our experience does not include any cases of severe balanoposthitis and phimosis of

PB:KMOSIS AND DIABETES IVIELUTUS

recent origin treated with resolution of phimosis. Circumcision may not be necessary in all such patients. However, to date we have circumcised all patients in order to eliminate recurrent infections of the prepuc~ and glans. It would seem that circumcision will most likely correct phimosis and prevent further problems m a diabetic. SUMMARY

Of 156 patients more than 18 years old who underwent circumcision, 22 had long-standing phi-

407

mosis, 110 had phimosis of recent origin and 24 had redundant foreskins (no phimosis). Of the 110 patients with recent phimosis, 35 had diabetes mellitus. Of those with diabetes, approximately 75 per cent had been previously undiagnosed. Of the remaining 46 patients in the series, only 3 had diabetes mellitus. Therefore, it seems that patients more than 18 years old with phimosis of recent origin have a 31.8 per cent chance of having diabetes mellitus. All adults with recently acquired phimosis should be evaluated for diabetes mellitus.