Using the Appraisal of Recommendations for Research and Evaluation II (AGREE II) instrument, researchers sought to identify and critically appraise available clinical practice guidelines (CPGs) addressing male circumcision. An electronic database, CPG database, and national/international associations giving guidelines to support clinical decision-making for male circumcision were used to perform a literature search. They chose pediatric-focused CPGs about male circumcision that were released between January 2010 and December 2020. The search eliminated non-English CPGs and publications containing narrative reviews, original research, training manuals, patient and allied health professional recommendations, and technical guides. Complete CPG papers were evaluated (including full-text articles, additional documents, and related information). CPG quality was assessed in line with the AGREE II manual.
A total of 163 CPGs were found, with 93 being examined and 13 being evaluated. The intraclass correlation values for all AGREE II domains ranged from 0.82 (95% CI, 0.72-0.89) to 0.93 (95% CI, 0.90-0.95). Most CPGs rated well in the category of clarity of presentation but badly in the categories of application and editorial independence. The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Canadian Urological Association were the top three CPGs recognized. Most suggestions had consistent CPGs. Current CPGs were of varying quality, and doctors and health care professionals should consider the findings when deciding on acceptable male circumcision recommendations.