1
|
Uberoi M, Abdulcadir J, Ohl DA, Santiago JE, Rana GK, Anderson FWJ. Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum. Int J Impot Res 2022; 35:234-241. [PMID: 36274189 DOI: 10.1038/s41443-022-00619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
The removal of non-pathogenic foreskin from the penis of healthy neonates and infants for non-religious reasons is routinely practiced in many parts of the world. High level data from well-designed randomized controlled trials of circumcision in neonates and infants does not guide clinical practice. Reliable counts of immediate and short term circumcision complications are difficult to estimate. Emerging evidence suggests routine neonatal circumcision could lead to long term psychological, physical, and sexual complications in some men. The stigma associated with discussing circumcision complications creates a prevalence paradox where the presence of significant circumcision complications is higher than reported. Prior to the Internet, there were very few forums for men from diverse communities, who were troubled about their circumcision status, to discuss and compare stories. To investigate the long term consequences of circumcision, we reviewed 135 posts from 109 individual users participating in a circumcision grief subsection of Reddit, an internet discussion board. We identified three major categories of complications: physical such as pain during erections and lost sensitivity, psychological such as anxiety and violation of autonomy, and sexual such as feeling that the sexual experience was negatively altered or being unable to complete a sexual experience. We also identified a "discovery process" where some men described coming into awareness of their circumcision status. These findings suggest that neonatal circumcision can have significant adverse consequences for adult men. The removal of normal foreskin tissue should be limited to adult men who choose the procedure for cosmetic reasons or when medically indicated.
Collapse
|
2
|
Megged O, Koriat Y. The prevalence of vesicoureteral reflux in infants with first urinary tract infection following circumcision is similar to infants with UTI not following circumcision. Int Urol Nephrol 2019; 52:417-422. [PMID: 31784897 DOI: 10.1007/s11255-019-02352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Urinary tract infections (UTIs) are common serious bacterial infections in early infancy. Ritual circumcision in neonates may increase the risk of UTI within 2 weeks of the procedure. The aims of this study were to assess the prevalence and risk factors for vesicoureteral reflux (VUR) among young infants with first UTI following circumcision, and compare it with the prevalence of VUR among young infants with first UTI not related to circumcision. METHODS In this retrospective cohort study, the medical records of all children aged 0-100 days who were diagnosed with UTI at Shaare Zedek Medical Center between 2005 and 2012 were reviewed for demographic, clinical and laboratory data and for the presence of VUR in voiding cystourethrography (VCUG). RESULTS Four hundred and sixty eight cases of UTI were included. Infants with post-circumcision UTI in our study were more likely to have associated bacteremia and abnormal renal function tests. VCUG was done for 166 infants (35%). There was no statistically significant difference in the prevalence of abnormal VCUG between infants with UTI following circumcision, in comparison to infants with UTI not following circumcision (30% vs. 36%, p = NS). CONCLUSIONS The decision regarding the need for radiographic evaluation and prophylactic antibiotic treatment following UTI should be made regardless if infection was related to circumcision.
Collapse
Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center Affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel.
| | | |
Collapse
|
3
|
Eisenberg ML, Galusha D, Kennedy WA, Cullen MR. The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health. World J Mens Health 2018; 36:176-182. [PMID: 29623700 PMCID: PMC6119846 DOI: 10.5534/wjmh.180006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 01/22/2018] [Accepted: 01/28/2018] [Indexed: 12/18/2022] Open
Abstract
The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.
Collapse
Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Deron Galusha
- Statistician, Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT, USA
| | - William A Kennedy
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark R Cullen
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
4
|
Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J 2018; 12:E76-E99. [PMID: 29381458 PMCID: PMC5937400 DOI: 10.5489/cuaj.5033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
| |
Collapse
|
5
|
Schröder A. [Vesicoureteral reflux : Watchful waiting, surgery or antibiotic prophylaxis?]. Urologe A 2017; 56:1158-1163. [PMID: 28710643 DOI: 10.1007/s00120-017-0453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Primary vesicoureteral reflux (VUR) is a dynamic disease with several factors influencing its course. Therapeutic options range from watchful waiting to open surgery. Multiple risk factors for the development of pyelonephritis are identified, which then determine the decision for the appropriate treatment option. They include age, gender, history of pyelonephritis and renal scarring, bladder and bowel dysfunction (BBD), circumcision status and parental preference. The use of continuous antibiotic prophylaxis (CAP) is becoming increasingly controversial with antibiotic resistance being a major concern. Aggressive treatment of BBD and infant circumcision can greatly reduce the risk for pyelonephritis and should always be considered and discussed. This article is soley concerned with primary VUR.
Collapse
Affiliation(s)
- A Schröder
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| |
Collapse
|
7
|
Abstract
Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.
Collapse
|
8
|
Gyan T, Strobel N, McAuley K, Shannon C, Newton S, Tawiah-Agyemang C, Amenga-Etego S, Owusu-Agyei S, Forbes D, Edmond K. Health service provider education and/or training in infant male circumcision to improve short- and long-term morbidity outcomes: protocol for systematic review. Syst Rev 2016; 5:41. [PMID: 26931106 PMCID: PMC4774100 DOI: 10.1186/s13643-016-0216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/22/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There has been an expansion of circumcision services in Africa as part of a long-term HIV prevention strategy. However, the effect of infant male circumcision on morbidity and mortality still remains unclear. Acute morbidities associated with circumcision include pain, bleeding, swelling, infection, tetanus or inadequate skin removal. Scale-up of circumcision services could lead to a rise in these associated morbidities that could have significant impact on health service delivery and the safety of infants. Multidisciplinary training programmes have been developed to improve skills of health service providers, but very little is known about the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. This review aims to evaluate the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. METHODS/DESIGN The review will include studies comparing health service providers who have received education and/or training to improve their skills for infant male circumcision with those who have not received education and/or training. Randomised controlled trials (RCTs) and cluster RCTs will be included. The outcomes of interest are short-term morbidities of the male infant including pain, infection, tetanus, bleeding, excess skin removal, glans amputation and fistula. Long-term morbidities include urinary tract infection (UTI), HIV infection and abnormalities of urination. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL and DARE), WHO databases and reference list of papers will be searched for relevant articles. Study selection, data extraction and synthesis and risk of bias assessment using the Cochrane risk of bias assessment tool will be conducted. We will calculate the pooled estimates of the difference in means and risk ratios using random effects models. If insufficient data are available, we will present results descriptively. DISCUSSION This review appears to be the first to be conducted in this area. The findings will have important implications for infant male circumcision programmes and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029345.
Collapse
Affiliation(s)
- Thomas Gyan
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. .,Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
| | - Natalie Strobel
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | - Kimberley McAuley
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | | | - Sam Newton
- School of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
| | - David Forbes
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| | - Karen Edmond
- School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia.
| |
Collapse
|