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Hariri MK, Rajabalian MB, Narouie B, Yousefi Tilaki SF, Rostami G, Jadidi S, Torabinavid P. Comparison the Diameter of the Urethral Meatus Before and After Circumcision and Evaluation of Urethral Stenosis. Glob Pediatr Health 2024; 11:2333794X241237059. [PMID: 38465207 PMCID: PMC10924556 DOI: 10.1177/2333794x241237059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/27/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives. This study focused on assessing the diameter of the meatus before and after circumcision to evaluate meatal stenosis. Methods. In this cross-sectional study, boys who met the inclusion criteria, their demographic parameters, and meatus diameter were recorded. Thirty days after circumcision, complications were evaluated meatus diameter was measured again and their information was analyzed by SPSS 26 software. Results. Four hundred boys were studied, and it was found that 41 cases (10.3%) developed meatal stenosis after circumcision, with 85% having a pre-circumcision meatus diameter of 4 mm or less. Statistical analysis revealed a significant correlation (P < .05) between smaller pre-circumcision meatus diameter and postoperative meatal stenosis. Conclusions. The study concludes that a smaller meatus diameter before circumcision significantly increases the risk of postoperative tightness. It suggests prophylactic measures like meatus dilatation or applying topical ointment for those at high risk (meatus diameter ≤ 4 mm) to prevent or mitigate postoperative meatal stenosis.
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Affiliation(s)
| | | | - Behzad Narouie
- Zahedan University of Medical Sciences, Zahedan, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Sajedeh Jadidi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alsowayan OS, Al Zahrani AM, Basalelah JH, Al Madi MK, Al Humam AA, Al Otaibi AN, AlKhamis AA, Fadaak KH, Al Suhaibani SS, El Darawany HM. A prospective randomized controlled trial measuring satisfaction and parents stress after Gomco and Plastibell infant circumcision. Pediatr Surg Int 2024; 40:51. [PMID: 38324024 DOI: 10.1007/s00383-024-05633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE To compare the physician and parental satisfactions between the two types of circumcision maneuvers used in our units, Gomco and Plastibell circumcision. METHODOLOGY This study was performed from 2019 to 2021. A total of 190 children were circumcised either by Gomco or Plastibell procedure. Each child was evaluated during the procedure, immediately after the operation, and 1, 2, and 3 weeks after the procedure. Data were collected, statistically analyzed using SPSS version 25. RESULTS A total of 190 children underwent circumcision from 2019 to 2021. Of the total 190, 98 children (51.6%) underwent circumcision by Gomco, while 92 (48.4%) underwent circumcision by Plastibell. Bleeding was significantly higher in Plastibell method, while excess skin was significantly higher in Gomco method (p value 0.048). Physician evaluation results show no significant difference between both methods in late physician evaluation. 23/92 (28%) of parents were not satisfied after Plastibell circumcision, compared to 8/98 (8.2%) of parents who were not satisfied with the results of Gomco circumcision (p value 0.002). CONCLUSION Gomco needs a longer operative time, and Plastibell circumcision is less preferable by parents. There is no significant difference in physician satisfaction between the two procedures, but parents are less satisfied with Plastibell circumcision.
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Affiliation(s)
- Ossamah Saleh Alsowayan
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Abdullah Mousa Al Zahrani
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jumanah Hamad Basalelah
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maha Khalid Al Madi
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Abdlz Al Humam
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aali Naif Al Otaibi
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Kamel Hussien Fadaak
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaheed Saleh Al Suhaibani
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hamed Mohamed El Darawany
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Siroosbakht S, Rezakhaniha B. A comprehensive comparison of the early and late complications of surgical circumcision in neonates and children: A cohort study. Health Sci Rep 2022; 5:e939. [PMID: 36425897 PMCID: PMC9679242 DOI: 10.1002/hsr2.939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND AIMS Major circumcision complications are rare; however, circumcision arouses distress in some special cases. The present study aimed to compare infancy and childhood regarding the frequency and relative risk of early and late complications of circumcision. METHODS This study was a retrospective cohort data analysis including 240 neonates and 240 children referred for circumcision from 2015 to 2021. All circumcisions were performed using the surgical dorsal-ventral slits method. A Cox proportional hazard model was used to assess the relative risk (RR) of complications at a confidence Interval of 95%. RESULTS The mean age was 19.32 ± 6.5 days for the neonates and 46.1 ± 8.8 months for the children. In general, complications occurred in 61 boys (12.7%), 40 neonates (8.3%), and 21 children (4.4%) (p˂0.001). Bleeding was the most common early complication in six neonates (2.5%) and three children (1.3%), and meatal stenosis was the most common late complication in 10 neonates (4.2%) and four children (1.6%). Meatal web was observed in 11 neonates (4.6%) and four children (1.6%), and the incomplete removal of the prepuce, as "not very satisfactory", was also noticed in nine neonates (3.75%) and three children (1.3%). The circumcision complications were significantly more frequent in neonates than in children (RR = 2.6, 95% CI 1.46-4.71, p<0.001). The neonatal circumcisions had a significant risk of the incomplete removal of the prepuce, meatal web, and meatal stenosis compared to children (RR = 3, 95% CI 5.83-10.81, p<0.04; RR = 2.75, 95% CI 0.9-8.3, p˂0.03; RR = 2.5, 95% CI 0.8-7.75, p<0.04, respectively). CONCLUSION The risk of complications is higher in neonates than children. The incomplete removal of prepuce, meatal web, and meatal stenosis are significantly higher in neonates than in children. Before prohibiting or recommending this procedure, practitioners should provide comprehensive information about its risks and benefits. Parents should weigh up the risks and benefits and make the best decision regarding their personal beliefs and customs.
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Affiliation(s)
- Soheila Siroosbakht
- Department of Pediatrics, Golestan HospitalAJA University of Medical SciencesTehranIran
| | - Bijan Rezakhaniha
- Department of Urology, Imam Reza HospitalAJA University of Medical SciencesTehranIran
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Shokri Varniab Z, Pourabhari Langroudi A, Neishabouri A, Torabinavid P, Arbab M, Heidari F, Milani SM, Eftekharzadeh S, Sabetkish S, Kajbafzadeh AM. Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up. Ir J Med Sci 2022; 192:707-711. [PMID: 35657540 DOI: 10.1007/s11845-022-03040-8] [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: 02/27/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions. AIM This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device. METHODS This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7-17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis. RESULTS Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026). CONCLUSION The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.
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Affiliation(s)
- Zahra Shokri Varniab
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Ashkan Pourabhari Langroudi
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Afarin Neishabouri
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Parham Torabinavid
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Mona Arbab
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran.,Department of Radiation Oncology, Indiana University, Indianapolis, IN, USA
| | - Firouzeh Heidari
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Mohammad Milani
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Sahar Eftekharzadeh
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Shabnam Sabetkish
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran.
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Acimi S, Abderrahmane N, Debbous L, Bouziani N, Mansouri JM, Acimi MA, Boukhari Y, Hadjeb N, Yazi AE. Prevalence and causes of meatal stenosis in circumcised boys. J Pediatr Urol 2022; 18:89.e1-89.e6. [PMID: 34740536 DOI: 10.1016/j.jpurol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The prevalence of meatal stenosis after circumcision remains unclear, and its causes are unknown. OBJECTIVE To know the prevalence and the causes of meatal stenosis after circumcision in boys. STUDY DESIGN Between October 2018 and April 2019, we carried out a prospective cross-sectional study on 1031 circumcised boys, aged 5-8 years (mean age 6.1 years ± 0.3 years), enrolled in the first level of primary school. All enrolled children underwent genitourinary examination. Moreover, an anonymous questionnaire was filled-in by one of the parents. RESULTS The screening revealed the presence of meatal stenosis in 185 children, representing a prevalence of 17.9% of cases (95% CI = 15.6-20.3). Analysis of the results using both the univariate and multivariate mode brought out some common risk factors such as a foreskin that completely adheres to the glans with forceful retraction of the prepuce and the use of a healing product: Beta-sitosterol and Hydrocotyl (Centella Asiatica), rarely Trolamine. In addition, this study showed that boys circumcised during their first week of life are twice as likely to develop meatal stenosis than those circumcised between 7 and 12 months (OR = 2.08; 95% CI = 1.10-3.92, p = 0.021). DISCUSSION We believe that when the foreskin is fully attached to the glans, forced retraction of the prepuce most often causes a loss of the mucous membrane that covers the glans, making the glans less resistant to chemical attack, and therefore may play an important role in the development of meatal stenosis. However, This study is limited by the absence of a cohort of uncircumcised boys for comparison to see if the small diameter of the meatus is also present in this group. CONCLUSIONS This study showed that stenosis of the urethral meatus is a frequent complication of circumcision. Circumcision in the first week of life, complete adhesion of the foreskin to the glans, and the use of a healing product were associated with the risk of stenosis development.
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Affiliation(s)
- Smail Acimi
- Department of Visceral Surgery, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria.
| | - Naima Abderrahmane
- Department of Visceral Surgery, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria
| | - Lamia Debbous
- Department of Visceral Surgery, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria
| | - Nacim Bouziani
- Department of Epidemiology, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria
| | | | - Mohammed Ali Acimi
- Department of Urology, EHU of Oran, Faculty of Medicine, University of Oran, Algeria
| | - Youcef Boukhari
- Responsible of Medical School, Department of Health, Oran, Algeria
| | - Naziha Hadjeb
- School Health Doctor, Department of Health, Oran, Algeria
| | - Aboubakr Essedik Yazi
- Department of Pediatric Surgery, CHU of Sidi Bel Abbes, Faculty of Medicine, University of Sidi Bel Abbes, Algeria
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Muhammad M, Agbo C. A systematic review of urethral complications following male circumcision: The importance of provider training. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Caglar O, Arslan R, Firinci B, Aydin ME, Karadeniz E, Nalci KA, Salman AB, Aydin MD. Comparing the effects of current circumcision techniques on dorsal root ganglia: an experimental study. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Circumcision is a surgical removal process of the preputium. Surgical excision and electric current cause neurodegeneration in the excised tissue-related neural network. This study investigates if circumcision and current surgical methods would cause histopathological changes in the penile tissue innervating pudendal nerve dorsal root ganglia.
Results
Vascular congestion occluded the microvessels, and degenerative changes were detected in postexcised penile tissue. Neuronal angulation, cytoplasmic condensation, nuclear shrinkage, and condensed nuclei were observed in the pudendal nerve ganglia. Moreover, the degenerated neuron (DN) densities of the pudendal nerve ganglia were 5 ± 2, 98 ± 22, 1093 ± 185, 236 ± 43 and 151 ± 19 in the control, the surgical circumcision, the monopolar cautery, the bipolar cautery and the thermocautery groups, respectively.
Conclusions
Although only the pudendal nerve endings are affected secondary to prepusium excision another pudendal axons can be damaged during bleeding control with cautery, the destruction of the neuron that sends this axon initiates a general inflammation in that ganglion. As a result, there may be a somatosensitive innervation defect in extrapenile tissues innervated by this ganglion. High-voltage electric devices should not be used unless obligatory.
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Abid AF, Hussein NS. Meatal stenosis posttraditional neonatal circumcision-cross-sectional study. Urol Ann 2021; 13:62-66. [PMID: 33897167 PMCID: PMC8052904 DOI: 10.4103/ua.ua_30_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022] Open
Abstract
Context: Circumcision holds a unique place in the daily practice of urology. Heat cautery device is the most common local technique used, we found it can cause meatal stenosis (MS) and its sequels. Aim: The study aims to determine the incidence, presenting symptoms of MS and its relation to local traditional neonatal circumcision techniques among our children. Settings and Design: This study was retrospectively study. Materials and Methods: A total of 150 children who circumcised during the infancy period, outside medical institutes, and they circumcised using local traditional techniques either heating cautery devices or surgical knives. Statistical Analysis: Of data were carried out using the Statistical Packages for the Social Sciences - version 25 (IBM Corporation). Results: Of 150 children, 60 (40%) had MS. The mean age at the time of diagnosis was 5.98 ± 3.06 years (range 1–13 years) and the majority of patients were within the age group of 5–9 years (n = 31, 51.7%), median 6.0 years. The incidence of MS was significantly higher (P = 0.037) among a group of children circumcised with a heating device in comparison with the circumcised group with other methods. Forty-six children (76.7%) were symptomatic and fourteen children (23.3%) diagnosis of MS had performed incidentally. Conclusions: MS is a long-term complication of neonatal circumcision with a late presentation and sequels. It is more common among group circumcised using heating cautery. We recommend using heating cautery cautiously.
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Affiliation(s)
- Ammar Fadil Abid
- Department of Urology, AL Yarmouk Hospital, Medical College, AL Mustansiriyah University, Baghdad, Iraq
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Maison POM, Yahaya I, Mensah S, Apraku C, Egyir E. An assessment of the training and practice of circumcision by medical circumcisers in Ghana. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Circumcision is a common procedure in most parts of sub-Saharan Africa with an estimated prevalence of 95% in Ghana. It has been documented that most circumcision related injuries in Ghana occur after circumcision by health care professionals who perform these circumcisions in hospitals and other healthcare facilities. In spite of the high rates of circumcision in Ghana, the expertise of circumcision providers and the safety of their practice has not been assessed. This study evaluates the training and practice of circumcision by health care professionals from across the country.
Methods
This is a questionnaire-based study of health care professionals who perform circumcision in Ghana. Data was extracted from pre-conference evaluation questionnaire completed by participants attending a circumcision training workshop from January to October 2019. These participants included responses on their training and practice of circumcision. Data was captured using the Epi-data software and analyzed with PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.
Results
There were 378 participants seen over the study period who already performed circumcision. The majority of them were midwives 281 (74.3%), followed by general nurses 89 (23.5%). The duration of practice of circumcision ranged from 4 months to 23 years and one-third of them (33.3%) had practiced circumcision for less than 1 year. The forceps guided technique was the most common (53.2%) circumcision technique used followed by the dorsal slit technique (24.1%). None of these participants who performed circumcision had any formal training on the procedure and all of them had experienced at least one adverse event such as excessive bleeding, insufficient skin coverage or redundant foreskin. Six (6) of them had seen patients who reported later with urethrocutaneous fistula and two of them had caused glans amputations. Only 102 (27%) of these participants offered anesthesia for circumcision.
Conclusion
The majority of medical circumcisers in Ghana have no formal training for circumcision. They require formal circumcision training and certification to improve the practice of circumcision in Ghana.
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Bawazir OA. A controlled trial of Gomco versus Plastibell for neonatal circumcisions in Saudi Arabia. Int J Pediatr Adolesc Med 2020; 7:132-135. [PMID: 33094142 PMCID: PMC7567998 DOI: 10.1016/j.ijpam.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/03/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gomco or Plastibell devices are the most widely used method for circumcision. The present work was aimed to assess the incidence of complications in infants of ages up to six months in two used methods. METHODS It was a prospective randomized study conducted at a pediatric surgery clinic in 3 hospitals in Jeddah, Saudi Arabia. Eight hundred and five children, their ages were less than 6 months were enrolled for the present work. Children were randomized into two groups: Groups P and G using Plastibell and Gomco Circumcision methods, respectively. Statistical analysis of data was performed by using SPSS Version 17. Chi-square test and independent sample t-test was applied to compare both qualitative and quantitative variables, respectively. P-value was considered as significant difference at <0.05. RESULTS Seven hundred eighty three children were were enrolled in this investigation. Plastibell method was concomitant with low volume of bleeding in comparison with Gomco method (P < 0.001). Incidence of complications including infection, penile edema, proximal migration and redundant skin was higher in Plastibell device method (P<0.05). CONCLUSION Gomco circumcision is the safer method and is accompanied with lowest rate of complication.
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Bauer AZ, Kriebel D, Herbert MR, Bornehag CG, Swan SH. Prenatal paracetamol exposure and child neurodevelopment: A review. Horm Behav 2018; 101:125-147. [PMID: 29341895 DOI: 10.1016/j.yhbeh.2018.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The non-prescription medication paracetamol (acetaminophen, APAP) is currently recommended as a safe pain and fever treatment during pregnancy. However, recent studies suggest a possible association between APAP use in pregnancy and offspring neurodevelopment. OBJECTIVES To conduct a review of publications reporting associations between prenatal APAP use and offspring neurodevelopmental outcomes. METHODS Relevant sources were identified through a key word search of multiple databases (Medline, CINAHL, OVID and TOXNET) in September 2016. All English language observational studies of pregnancy APAP and three classes of neurodevelopmental outcomes (autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intelligence quotient (IQ)) were included. One reviewer (AZB) independently screened all titles and abstracts, extracted and analyzed the data. RESULTS 64 studies were retrieved and 55 were ineligible. Nine prospective cohort studies fulfilled all inclusion criteria. Data pooling was not appropriate due to heterogeneity in outcomes. All included studies suggested an association between prenatal APAP exposure and the neurodevelopmental outcomes; ADHD, ASD, or lower IQ. Longer duration of APAP use was associated with increased risk. Associations were strongest for hyperactivity and attention-related outcomes. Little modification of associations by indication for use was reported. CONCLUSIONS Together, these nine studies suggest an increased risk of adverse neurodevelopmental outcomes following prenatal APAP exposure. Further studies are urgently needed with; precise indication of use and exposure assessment of use both in utero and in early life. Given the current findings, pregnant women should be cautioned against indiscriminate use of APAP. These results have substantial public health implications.
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Affiliation(s)
- Ann Z Bauer
- Department of Public Health, University of Massachusetts, 1 University Avenue, Lowell, MA, 01854, USA.
| | - David Kriebel
- Department of Public Health, University of Massachusetts, 1 University Avenue, Lowell, MA, 01854, USA.
| | - Martha R Herbert
- Department of Neurology, MGH, Harvard Medical School, A.A. Martinos Centre for Biomedical Imaging, MGH/MIT/Harvard 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Carl-Gustaf Bornehag
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; Department of Health Sciences, Karlstad University, Karlstad, Sweden.
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
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Van Howe R, Storms MR. Time to acknowledge the obvious. Surgeon 2018; 16:125-126. [PMID: 28865847 DOI: 10.1016/j.surge.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
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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
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Moradi M, Kaseb K, Rezaee H. Giant urethrocutaneous fistula following ritual circumcision in an infant with congenital anterior urethral diverticula. SAGE Open Med Case Rep 2017; 5:2050313X17745205. [PMID: 29276598 PMCID: PMC5734556 DOI: 10.1177/2050313x17745205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/06/2017] [Indexed: 11/15/2022] Open
Abstract
Circumcision is the most common operation with multiple complications. One of these complications is surgical such as urethrocutaneous fistula due to traumatic and ischemic injury during the operation. A 9-month infant with a history of swelling on the ventral aspect of the penile urethra during micturition was circumcised ritually in 3 months of birth and 6 months later was referred to Imam Reza Hospital with giant ventral fistula in the distal of the penis.
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Affiliation(s)
- Mahmoudreza Moradi
- Urology Department in Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kaveh Kaseb
- Department of Urology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Haress Rezaee
- Department of Urology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Morris BJ, Krieger JN. Does Circumcision Increase Meatal Stenosis Risk?-A Systematic Review and Meta-analysis. Urology 2017; 110:16-26. [PMID: 28826876 DOI: 10.1016/j.urology.2017.07.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/11/2017] [Accepted: 07/20/2017] [Indexed: 12/30/2022]
Abstract
CONTEXT Meatal stenosis (MS) as a potential complication of male circumcision and controversy regarding the magnitude of risk. OBJECTIVES To conduct a systematic review and meta-analyses to assess (1) MS diagnosis after circumcision, (2) the potential association of MS with circumcision, and (3) a potential method of prevention. DATA SOURCES PubMed, Google Scholar, Cochrane Library and bibliographies of original studies were searched using the keywords circumcision and stenosis or stricture. STUDY SELECTION Studies containing original data on MS following circumcision at any age. DATA EXTRACTION Two reviewers independently verified study design and extracted data. RESULTS Thirty eligible studies were retrieved. A random effects meta-analysis of 27 studies (350 MS cases amongst 1,498,536 males) found that the risk of MS in circumcised males was 0.656% (95% confidence interval 0.435-0.911). Meta-analysis of 3 observational studies that compared MS prevalence in circumcised and uncircumcised males found non-significantly higher prevalence in circumcised males (odds ratio 3.20; 95% confidence interval 0.73-13.9). Meta-analysis of 3 randomized controlled trials investigating the effect of petroleum jelly application to the glans after circumcision found that this intervention was associated with MS risk reduction (relative risk 0.024; 95% confidence interval 0.0048-0.12). CONCLUSION MS risk after circumcision is low (< 1%). Weak evidence suggests that MS risk might be higher in circumcised boys and young adult males. Risk is reduced by petroleum jelly application. Further research on MS arising from lichen sclerosus in older uncircumcised males is needed.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia; University of Washington School of Medicine, Department of Urology, Seattle, WA.
| | - John N Krieger
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia; University of Washington School of Medicine, Department of Urology, Seattle, WA
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17
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18
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Re: 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. Surgeon 2017; 16:126-129. [PMID: 28869139 DOI: 10.1016/j.surge.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/06/2017] [Indexed: 11/20/2022]
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Castagnetti M, Esposito C. Phimosis in a 10-yr-old Boy Without Urinary Infection-How to Inform Parents: For Circumcision. Eur Urol Focus 2017; 3:149-150. [PMID: 28753815 DOI: 10.1016/j.euf.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Circumcision can be a viable option for phimosis in a 10-yr-old boy, also if asymptomatic, in the presence of skin alterations or if the parents prefer avoid observation. Morbidity is minimal if the procedure is performed in a hospital setting.
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Affiliation(s)
- Marco Castagnetti
- Section for Pediatric Urology, University Hospital of Padova, Padua, Italy.
| | - Ciro Esposito
- Department of Paediatrics, Federico II University of Naples, Naples, Italy
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Morris BJ, Kennedy SE, Wodak AD, Mindel A, Golovsky D, Schrieber L, Lumbers ER, Handelsman DJ, Ziegler JB. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediatr 2017; 6:89-102. [PMID: 28224100 PMCID: PMC5296634 DOI: 10.5409/wjcp.v6.i1.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/17/2016] [Accepted: 12/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether recent evidence-based United States policies on male circumcision (MC) apply to comparable Anglophone countries, Australia and New Zealand. METHODS Articles in 2005 through 2015 were retrieved from PubMed using the keyword "circumcision" together with 36 relevant subtopics. A further PubMed search was performed for articles published in 2016. Searches of the EMBASE and Cochrane databases did not yield additional citable articles. Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further. The most relevant and representative of the topic were included. Bibliographies were examined to retrieve further key references. Randomized controlled trials, recent high quality systematic reviews or meta-analyses (level 1++ or 1+ evidence) were prioritized for inclusion. A risk-benefit analysis of articles rated for quality was performed. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information, including policies and Australian data on claims under Medicare for MC. RESULTS Evidence-based policy statements by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and "ballooning" during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible infections in both sexes, genital ulcers, and penile, prostate and cervical cancer. Our risk-benefit analysis showed that benefits exceeded procedural risks, which are predominantly minor, by up to 200 to 1. We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. Wide-ranging evidence from surveys, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function, sensitivity or pleasure. United States studies showed that early infant MC is cost saving. The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews. CONCLUSION Affirmative MC policies are needed in Australia and New Zealand. Routine provision of accurate, unbiased education, and access in public hospitals, will maximize health and financial benefits.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Sean E Kennedy
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Alex D Wodak
- St Vincent’s Hospital and Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW 2010, Australia
| | - Adrian Mindel
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Leslie Schrieber
- Department of Medicine, Sydney Medical School, Royal North Shore Hospital, Sydney, NSW 2060, Australia
| | - Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia
| | - David J Handelsman
- Department of Medicine and ANZAC Research Institute, Concord Hospital, Sydney, NSW 2139, Australia
| | - John B Ziegler
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
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Gyan T, McAuley K, Strobel NA, Shannon C, Newton S, Tawiah-Agyemang C, Amenga-Etego S, Owusu-Agyei S, Kirkwood B, Edmond KM. Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana. Trop Med Int Health 2017; 22:312-322. [PMID: 27990718 DOI: 10.1111/tmi.12829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities in rural Ghana. METHODS Population-based, cross-sectional study conducted between May and December 2012 involving 2850 circumcised infant males aged under 12 weeks. Multivariable logistic regression models were adjusted for maternal age, maternal education, income, birthweight and site of circumcision. RESULTS A total of 2850 (90.7%) infant males were circumcised. Overall, the risk of experiencing a morbidity (defined as complications occurring during or after the circumcision procedure as reported by the primary caregiver) was 8.1% (230). Risk was not significantly increased if the circumcision was performed by informal providers (121, 7.2%) vs. formal health service providers (109, 9.8%) [adjusted odds ratio (aOR) 1.11, 95% CI 0.80-1.47, P = 0.456]. Poor hygiene practices were associated with significantly increased risk of morbidity: no handwashing [148 (11.7%)] (aOR 1.78, 95% CI 1.27-2.52, P = 0.001); not cleaning circumcision instruments [174 (10.6%)] (aOR 1.80, 95% CI 1.27-2.54, P = 0.001); and uncleaned penile area [190 (10.0%)] (aOR 1.84, 95% CI 1.25-2.70, P = 0.002). CONCLUSION The risk of morbidity after infant male circumcision in rural Ghana is high, chiefly due to poor hygiene practices. Governmental and non-governmental organisations need to improve training of circumcision providers in hygiene practices in sub-Saharan Africa.
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Affiliation(s)
- Thomas Gyan
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.,Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Kimberley McAuley
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Natalie A Strobel
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | | | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Betty Kirkwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen M Edmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
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22
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Friedman B, Khoury J, Petersiel N, Yahalomi T, Paul M, Neuberger A. Pros and cons of circumcision: an evidence-based overview. Clin Microbiol Infect 2016; 22:768-774. [PMID: 27497811 DOI: 10.1016/j.cmi.2016.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/17/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made.
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Affiliation(s)
- B Friedman
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - J Khoury
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - N Petersiel
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - T Yahalomi
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel
| | - M Paul
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - A Neuberger
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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23
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Frisch M, Earp BD. Circumcision of male infants and children as a public health measure in developed countries: A critical assessment of recent evidence. Glob Public Health 2016; 13:626-641. [DOI: 10.1080/17441692.2016.1184292] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Division of Epidemiology and Disease Surveillance, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark
| | - Brian D. Earp
- The Hastings Center Bioethics Research Institute, Garrison, NY, USA
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Yuruk E, Temiz MZ, Colakerol A, Muslumanoglu AY. Mucosal cuff length to penile length ratio may affect the risk of premature ejaculation in circumcised males. Int J Impot Res 2016; 28:54-6. [PMID: 26700215 DOI: 10.1038/ijir.2015.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 09/17/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023]
Abstract
Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.
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Affiliation(s)
- E Yuruk
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - M Z Temiz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - A Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - A Y Muslumanoglu
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Telli O, Karakan T, Sarici H, Kabar M, Ozgur BC, Eroglu M. Can circumcision be a risk factor in premature ejaculation? Rev Int Androl 2014. [DOI: 10.1016/j.androl.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The American Academy of Pediatrics recently issued a statement that the health benefits of newborn male circumcision exceed the risks and therefore justify access to the procedure for families who choose it. Further, clinicians are charged with providing factually correct information that communicates the risks and benefits of elective newborn male circumcision in a nonbiased manner. However, many clinicians lack adequate information to discuss the risks and benefits of male circumcision. The purpose of this review is to highlight evidence on the risks and benefits of newborn male circumcision and provide clinicians with counseling points that can be used to guide discussion with parents considering newborn male circumcision.
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Tempark T, Wu T, Singer C, Shwayder T. Dermatological complications of circumcision: lesson learned from cases in a pediatric dermatology practice. Pediatr Dermatol 2013; 30:519-28. [PMID: 23683078 DOI: 10.1111/pde.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We discuss 11 cases of boys who presented with dermatologic complications of circumcision in an outpatient pediatric dermatology clinic. A medical practitioner had previously circumcised all patients during the newborn period. The majority of cases were found incidentally during initial thorough dermatologic examination. Late cutaneous complications included penile skin bridge, glandular adhesion of remnant foreskin, concealed penis, and a penile epidermal inclusion cyst. Minor surgical procedures under local anesthesia were performed in all but two cases. These cases should help dermatologists recognize the common late cutaneous complications of male newborn circumcision and provide insight into potential options for early intervention and management.
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Affiliation(s)
- Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Bodakçi MN, Bozkurt Y, Söylemez H, Hatipoglu NK, Penbegül N, Atar M, Sancaktutar AA. Relationship between premature ejaculation and postcircumcisional mucosal cuff length. Scand J Urol 2013; 47:399-403. [PMID: 23356828 DOI: 10.3109/21681805.2013.764350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aims of this study were to investigate the effect of circumcision conditions on postcircumcisional mucosal cuff length (MCL), and to determine the relationship between premature ejaculation (PE) and MCL. MATERIAL AND METHODS Circumcision histories and penile measurements were taken for 200 circumcised men. They were asked to complete the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire, and to measure and report intravaginal ejaculation latency time (IELT). RESULTS The mean age of all participants was 35.1 ± 8.5 (19-46) years. The mean MCL, penile skin length and total penile length of all participants were 14.6 ± 3.4 mm, 122 ± 11.8 mm and 136.6 ± 13.9 mm, respectively. Mean age at circumcision was 6.5 ± 5.8 years. Only 26 (13%) of the participants had been circumcised by a surgeon, and they had significantly shorter MCL than those who had been circumcised by others (p = 0.041). All 200 men enrolled in the study completed a PEDT, but only 141 of them measured correctly and reported their IELT. The mean PEDT score was 5.6 ± 5.9 and IELT was 3.8 ± 1.9 min. There was a strong and a negative correlation between PEDT scores and IELT (p = 0.000, and r = -0.785), but no correlation was shown between the mean penile measurements and PEDT and IELT scores of volunteers (p > 0.05). CONCLUSIONS Although the MCL did not change according to the place where it was performed, it was shorter in patients who had been circumcised by surgeons. The study results also demonstrated that there was no relationship between MCL or penile length and PE in terms of PEDT score and IELT in circumcised men.
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Abstract
Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP's 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association's template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners' competency in discussing circumcision's benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it. Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child. Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure. Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families. Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not. Elective circumcision should be performed only if the infant's condition is stable and healthy. Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management. Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision. If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns. Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing; Teach the procedure and analgesic techniques during postgraduate training programs; Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents; Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises. The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.
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Abstract
INTRODUCTION Task-shifting for male medical circumcision is proposed as a strategy to overcome the lack of surgeons and doctors in high HIV prevalence settings. We undertook a systematic review and meta-analysis to review the safety of task-shifting for circumcision in Africa. METHODS We searched online databases and conference websites up to July 2011 without language restriction for studies reporting outcomes of task-shifting for circumcision in Africa. Information was extracted independently and in duplicate on study characteristics, quality, and outcome data. Case reports and case series were excluded. RESULTS Ten studies met our inclusion criteria, providing outcome data on 25119 circumcisions. The proportion of adverse events ranged from 0.70 [95% confidence interval (CI) 0.44-1.02%] to 37.36% (95% CI 27.54-47.72%), with an overall pooled proportion of 2.31% (95% CI 1.46-3.16%; τ = 1.21; P < 0.001). Two studies reported outcomes separately for both doctors and non-physicians; there was no difference in the risk of adverse events by provider (pooled relative risk 1.18; 95% CI 0.78-1.78). The frequency of excessive bleeding ranged from 0.30 (0.09-0.65%) to 24.71% (16.27-34.26%) with an overall pooled prevalence of 0.55% (95% CI 0.13-0.97%). Infection occurred in 0.30 (0.14-1.47%) to 1.85% (0.07-5.96%) of cases, with an overall pooled proportion of 0.88% (95% CI 0.29-1.47%). All adverse events were reported to be non-severe. CONCLUSION Task-shifting of male medical circumcision to non-physician clinicians can be done safely, with reported rates of adverse events similar to doctors and specialists.
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Tailored sutureless meatoplasty: a new technique for correcting meatal stenosis. J Pediatr Urol 2012; 8:92-6. [PMID: 20980203 DOI: 10.1016/j.jpurol.2010.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 10/06/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Standard practice for meatoplasty includes the use of sutures to evert the mucosa. We present a novel technique that is equivalent to standard meatoplasty without the need for suturing. MATERIALS AND METHODS A retrospective chart review was performed of patients who presented with primary meatal stenosis in 2007-2009. One group underwent a tailored, sutureless meatoplasty performed by one surgeon. The second group underwent a standard meatoplasty with mucosal advancement and suturing of the mucosal edges by another surgeon. Data were collected regarding demographics, presenting symptoms, symptom resolution, and postoperative complications. These were then compared between the two groups. Preoperative and postoperative uroflowmetry data were collected for the sutureless group to demonstrate objective improvement. RESULTS Of 85 patients, aged 2-17 years, 60 underwent the tailored, sutureless procedure while 25 had a standard meatoplasty. The majority of patients presented with a deviated and/or narrowed stream of urine. There was no statistical difference between the two groups in regard to symptom resolution. Uroflowmetry data analyzed for 20 patients in the sutureless group demonstrated a significant improvement in Q(max) and flow pattern; there was no significant change in % post-void residual. No patient had a complication in either group, or presented with recurrence. CONCLUSIONS Tailored sutureless meatoplasty is comparable to meatoplasty with mucosal advancement in resolving symptoms, improving uroflowmetry parameters, and complication rate, but is more efficient and cost effective.
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Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol 2011; 7:526-8. [PMID: 20851685 DOI: 10.1016/j.jpurol.2010.08.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 08/06/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the incidence of meatal stenosis after neonatal circumcision. PATIENTS AND METHODS Male children (5-10 years old) who had been circumcised during the neonatal period and presented at our pediatric clinic for reasons other than urinary complaints were examined and interviewed regarding urination problems. RESULTS Of the 132 cases, 27 (20.4%) had severe meatal stenosis (diameter < 5 F). Thickening of the bladder and bilateral hydronephrosis (pyelocaliceal) were found in three cases (11.1%), and a voiding cystourethrogram was performed to reveal vesicoureteral reflux (VUR). One patient had grade II VUR in his right kidney and grade III in his left kidney; another had grade II VUR in both his kidneys. CONCLUSION These results highlight the importance of follow-up genital examination for all male children who have been circumcised during the neonatal period, to detect possible meatal stenosis.
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Affiliation(s)
- Marjan Joudi
- Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Senel FM, Demirelli M, Pekcan H. Mass Circumcision with a Novel Plastic Clamp Technique. Urology 2011; 78:174-9. [DOI: 10.1016/j.urology.2010.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/11/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
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Moslemi MK, Abedinzadeh M, Aghaali M. Evaluation of epidemiology, safety, and complications of male circumcision using conventional dissection surgery: experience at one center. Open Access J Urol 2011; 3:83-7. [PMID: 24198639 PMCID: PMC3818939 DOI: 10.2147/oaju.s17913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Circumcision can be performed for a variety of techniques, including conventional dissection surgery or a Plastibell device, and has religious, ritual, or medical roots. In countries like Iran, circumcision is done purely on religious grounds. In this study, we outline 390 cases in our practice and describe the epidemiology, indications, surgical technique used, and the early complications. MATERIALS AND METHODS In this retrospective study, the charts for 390 circumcision cases were analyzed for the period March 2005 to August 2010. We reviewed all cases, noting age, indication, type of anesthesia used, technique, cosmetic appearance, and any potential early complications. All cases were followed up 1-4 weeks postoperatively and their notes were evaluated. RESULTS The age of children who underwent circumcision ranged from 3 weeks to 14 years, with a mean age of 4.25 years. The most common age for circumcision was 4-5 years (14.6%), and the least common age was 11-12 years (1.5%). In 372 cases (95%), the parents had opted for the procedure for religious reasons, and in 18 cases (5%), there was a medical indication, including phimosis (11 cases, 3%), urinary tract infection (5 cases, 1.2%), and balanoposthitis (2 cases, 0.8%). No major early complications were found in our series. Cosmetic appearance was satisfactory in all cases by 4 weeks after the operation. CONCLUSION Circumcision was performed for religious reasons in our cases, although medical indications sometimes modified the timing of the procedure. Conventional dissection surgery for circumcision was safe, effective, and without any major complications.
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Affiliation(s)
- Mohammad Kazem Moslemi
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
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Revisions after unsatisfactory adult circumcisions. Int Urol Nephrol 2010; 43:431-5. [DOI: 10.1007/s11255-010-9820-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
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Abstract
Three randomized controlled trials in sub-Saharan Africa have shown that circumcision reduces the risk of acquiring HIV infection in men by approximately 60%. In this paper, we review the evidence that male circumcision protects against infection with HIV and other sexually transmitted infections (STIs) in men and their female partners. Data from the clinical trials indicate that circumcision may be protective against genital ulcer disease, Herpes simplex type 2, Trichomonas vaginalis and human papillomavirus infection in men. No evidence exists of a protective effect against Chlamydia trachomatis or Neisseria gonorrhea. There is weak evidence that circumcision has a direct protective effect on HIV infection in women, although there is likely to be an indirect benefit, since HIV prevalence is likely to be lower in circumcised male partners. Although there is little evidence from the trials of serious adverse events from the procedure and of behavioural risk compensation among circumcised men, essential operational research is being conducted to evaluate these key issues outside the trial setting as circumcision services are expanded. Following the publication of the clinical trial results in early 2007, the World Health Organization/UNAIDS has advised that promotion of male circumcision should be included as an additional HIV strategy for the prevention of heterosexually acquired HIV infection in men in areas of high HIV prevalence. As circumcision services are expanded in settings where resources are limited, non-physician providers including nurses will play an important role in the provision of services.
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Affiliation(s)
- Natasha Larke
- Epidemiology and Medical Statistics, Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London
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Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol 2010; 10:2. [PMID: 20158883 PMCID: PMC2835667 DOI: 10.1186/1471-2490-10-2] [Citation(s) in RCA: 208] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 02/16/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. The aim of this paper is to summarize the literature on frequency of adverse events following pediatric circumcision, with a focus on developing countries. METHODS PubMed and other databasess were searched with keywords and MeSH terms including infant/newborn/pediatric/child, circumcision, complications and adverse events. Searches included all available years and were conducted on November 6th 2007 and updated on February 14th 2009. Additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male circumcision.Studies were included if they contained data to estimate frequency of adverse events following neonatal, infant and child circumcision. There was no language restriction. A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included. RESULTS Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates. CONCLUSIONS Studies report few severe complications following circumcision. However, mild or moderate complications are seen, especially when circumcision is undertaken at older ages, by inexperienced providers or in non-sterile conditions. Pediatric circumcision will continue to be practiced for cultural, medical and as a long-term HIV/STI prevention strategy. Risk-reduction strategies including improved training of providers, and provision of appropriate sterile equipment, are urgently needed.
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Affiliation(s)
- Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Natasha Larke
- MRC Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Daniel Halperin
- Dept of Global Health and Population, Harvard School of Public Health, 665 Huntington St, Boston, MA, USA
| | - Inon Schenker
- The Jerusalem AIDS Project, 4 Eliezer Hagadol Street, Jerusalem 91072, Israel
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Circumcision complications associated with the Plastibell device and conventional dissection surgery: a trial of 586 infants of ages up to 12 months. Adv Urol 2008:606123. [PMID: 19009030 PMCID: PMC2581731 DOI: 10.1155/2008/606123] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 09/02/2008] [Indexed: 11/26/2022] Open
Abstract
Conventional dissection surgery (CDS) or using the Plastibell device (PD) is the method most frequently employed for circumcision. The aim of this study was to evaluate two methods in terms of the incidence of complications in infants of ages up to 12 months. In a prospective study, 586 infants equal to or less than 12 months were studied from 2002 to 2008, and complications between the two groups were assessed. The overall rates of complications in CDS and PD groups were 1.95% and 7.08%, respectively. In each group, the rate of complications was not different among children who had a normal weight, compared to those of a lower or upper (10%) weight. There was a significant positive correlation between the age and weight of subjects within the time of ring separation (P < .001). The results of this study suggest the PD method for neonates and low-weight infants with thin prepuce and the CDS for other infants.
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Vardi A, Guy L, Boiteux JP. Circoncision et VIH. Prog Urol 2008; 18:331-6. [DOI: 10.1016/j.purol.2008.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 03/11/2008] [Indexed: 11/27/2022]
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VanderBrink BA, Gitlin J, Palmer LS. Uroflowmetry Parameters Before and After Meatoplasty for Primary Symptomatic Meatal Stenosis in Children. J Urol 2008; 179:2403-6; discussion 2406. [DOI: 10.1016/j.juro.2008.01.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Brian A. VanderBrink
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, Long Island, New York
| | - Jordan Gitlin
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, Long Island, New York
| | - Lane S. Palmer
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, Long Island, New York
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Affiliation(s)
- Padraig Malone
- Southampton University Hospital, Department of Paediatric Urology, Southampton SO16 6YD.
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Abstract
Preputium is the extended part of the foreskin of the penis and covers the glans penis. Several congenital anomalies of the preputium such as disproportionate preputial growth, epidermoid cyst, and phimosis have been reported previously. Although lack of the ventral part of preputium is associated with hypospadias, there are no articles about complete agenesis of the preputium. Here, we report a case with the diagnosis of "complete preputial agenesis." This case is the first in our knowledge.
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Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence? REPRODUCTIVE HEALTH MATTERS 2007; 15:33-44. [DOI: 10.1016/s0968-8080(07)29302-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Muula AS, Prozesky HW, Mataya RH, Ikechebelu JI. Prevalence of complications of male circumcision in Anglophone Africa: a systematic review. BMC Urol 2007; 7:4. [PMID: 17335574 PMCID: PMC1821037 DOI: 10.1186/1471-2490-7-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/02/2007] [Indexed: 11/10/2022] Open
Abstract
Background There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. Methods A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. Results There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. Conclusion The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision.
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Affiliation(s)
- Adamson S Muula
- Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Epidemiology, Denis and Joan Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Hans W Prozesky
- Department of Medicine, Health Sciences Faculty, University of Stellenbosch, Tygerberg, South Africa
| | - Ronald H Mataya
- Department of Global Health, School of Public Health, Loma Linda University, California, USA
| | - Joseph I Ikechebelu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Aydur E, Gungor S, Ceyhan ST, Taiimaz L, Baser I. Effects of childhood circumcision age on adult male sexual functions. Int J Impot Res 2007; 19:424-31. [PMID: 17314981 DOI: 10.1038/sj.ijir.3901545] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The effects of childhood circumcision on male sexual function have been debated. However, there are no studies, to our knowledge, that assess the possible effects of childhood circumcision age on male sexual function. In an attempt to answer this question, we performed a prospective study to determine the possible relationship between circumcision age and male sexual function, using a validated questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction. We found no relationship between childhood circumcision age and overall sexual function; however some specific domains of sexual function (i.e. avoidance and communication) seemed to be affected by the age at circumcision procedure in this cohort of sexually active males. In addition, prevalence of sexual dysfunction was higher, with premature ejaculation being the most common dysfunction in the survey. We concluded that childhood circumcision age might affect some domains of male sexual function in adulthood, but not the overall function.
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Affiliation(s)
- E Aydur
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey.
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Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 2006; 6:21. [PMID: 16934157 PMCID: PMC1560152 DOI: 10.1186/1471-2490-6-21] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Accepted: 08/25/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem. METHODS The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision. RESULTS Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051). CONCLUSION We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.
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Affiliation(s)
- Linus I Okeke
- Surgery Department, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
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