1
|
Akyüz O, Tatar Z. Is it safe to use a thermocautery device for circumcision? Examination of the histopathological changes emerging after thermocautery-assisted circumcisions. Andrologia 2021; 53:e13968. [PMID: 33421180 DOI: 10.1111/and.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022] Open
Abstract
Multiple number of techniques and devices have been described concerning circumcision method so far. One of them is thermocautery device, and it has been widely used. Although there is controversy that the penis may be damaged due to the heat generated during the use of the device, not enough histopathological studies have been conducted. We aimed to determine the histopathological changes in human foreskin caused by heat after circumcision with thermocautery and to demonstrate the safety of the use of a thermocautery-assisted circumcision. Forty-one patients were divided into two groups according to the thermal energy used during cutting with thermocautery as follows: high temperature (Group 1, n = 22) and low temperature (Group 2, n = 19). The effect of the heat intensity and depth of the coagulation necrosis produced with thermocautery-assisted circumcisions performed at low and high temperatures were evaluated. The difference between the groups was not statistically significant. Tissue damage is extremely limited in thermocautery-assisted circumcisions, even when it is used at high temperatures. The thermocautery device can be used for effective and safe circumcisions.
Collapse
Affiliation(s)
- Osman Akyüz
- Medicine Hospital Department of Urology, Atlas University, Istanbul, Turkey
| | - Zeynep Tatar
- Patomer Pathological Cytological Research Center, Istanbul, Turkey
| |
Collapse
|
2
|
Circumcision in Hemophilia: A Multicenter Experience. J Pediatr Hematol Oncol 2021; 43:e33-e36. [PMID: 33003145 DOI: 10.1097/mph.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemophiliac patients and their families have social pressure to undergo circumcision, despite the potential complications. The objective of this study was to report our experience in the circumcision of hemophilia patients. MATERIALS AND METHODS We included 35 patients with hemophilia who had circumcision in 3 centers from January 2010 to August 2019. Their age ranged between 0.3 months and 8 years. Hemophilia a was classified as mild (n=3), moderate (n=4), and severe (n=28). Patients received 2 doses of factor VIII concentrate 50μ/kg, 1 hour before the procedure and 12 hours after it. RESULTS Four neonates were diagnosed with hemophilia after circumcision because of prolonged bleeding. Two patients with severe hemophilia A had bleeding after hospital discharge (6.5%). They received additional factor concentrate, and 1 patient had an extra stitch. Two patients had wound gaping (6.5%), and 1 patient had a wound infection (3.2%). CONCLUSION Hemophilia is not an absolute contraindication for circumcision. Circumcision of hemophilic children should be performed under appropriate conditions in hemophilia centers. Bleeding is not frequent but could be serious.
Collapse
|
3
|
Swaminathan N, Thatcher C, Staber JM. Haemostatic efficacy of single-dose factor administration in neonates with severe haemophilia undergoing circumcision. Haemophilia 2020; 26:786-792. [PMID: 32746496 DOI: 10.1111/hae.14122] [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: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Perioperative management of children with haemophilia undergoing surgery is a complex and understudied topic. Circumcision is the most common procedure performed in the neonatal period, and guidelines to prevent bleeding complications from circumcision are lacking. Treatment protocols vary widely, and many centres treat patients with factor products for up to two weeks after circumcision. There is an unmet need for studies evaluating optimal factor replacement therapy around the time of circumcision in neonates with severe haemophilia. AIM To determine the efficacy of a single dose of factor replacement before circumcision to prevent bleeding complications in neonates with severe haemophilia. METHODS We conducted a retrospective chart review of male infants born between January 2000 and June 2019. Male neonates with severe haemophilia diagnosed at the Iowa Hemophilia and Thrombosis Center (n = 22) and healthy newborn controls who underwent circumcision at the University of Iowa Hospitals were included. Data were collected from the electronic medical record. Neonates with severe haemophilia were separated into two groups-those pretreated with one dose of factor replacement before circumcision and those without pretreatment. RESULTS We observed that neonates with severe haemophilia pretreated with a single dose of factor VIII or factor IX replacement had significantly reduced bleeding complications, shorter hospital stay and required less therapeutic intervention compared with untreated patients. Importantly, pretreated patients had outcomes similar to healthy controls. CONCLUSIONS Our results demonstrate that a single dose of factor replacement before circumcision is effective to prevent bleeding in neonates with severe haemophilia.
Collapse
Affiliation(s)
- Neeraja Swaminathan
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Collin Thatcher
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Janice M Staber
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
4
|
Cakiroglu B, Gozukucuk A, Arda E, Tas T. Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status. Ther Adv Urol 2019; 11:1756287219882598. [PMID: 31662793 PMCID: PMC6792273 DOI: 10.1177/1756287219882598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: The objective of this study was to evaluate the reliability of thermocautery-assisted circumcision performed voluntarily in patients of poor countries. Material and methods: Between 2016 and 2019, 32,000 children aged 7 days to 17 years were circumcised in multiple countries. The patients’ urological examinations were done before the administration of local anaesthesia. Patients revealed to have undescended testicle, inguinal hernia, hypospadias, varicocele, penile rotation anomaly, epispadias and infection were not circumcised. All procedures were performed under local anaesthesia by using thermocautery. Afterwards, mucosa and skin were sutured using absorbable suture and the circumcised penis was dressed. Patients were instructed to remove the dressing after 3 days. Results: Bleeding, requiring surgical intervention and drug reactions were not observed. The most observed complication was mucosal oedema, which occurred in approximately one-quarter of patients (26%, 8320/32,000) and continued for 3–5 days after the surgery. The most serious complication was a trapped penis, which occurred in 25 patients (0.078%). In six (0.018%) cases, meatal stenosis developed. Wound infection developed in only 10 (0.03%) cases, through the formation of an aseptic environment. Penile adhesion was seen in 35 cases (0.1%) and improved with anti-inflammatory treatment without any surgical intervention. Conclusion: Thermocautery-assisted circumcision can be used as an effective, safe and useful technique with few complications and rapid healing rates.
Collapse
Affiliation(s)
- Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Saray Mah, Siteyolu Cad.No.7-9, İstanbul 34768, Turkey
| | - Ali Gozukucuk
- Department of Pediatric Surgery, Hisar Intercontinental Hospital, İstanbul, Turkey
| | - Ersan Arda
- Medical Faculty, Department of Urology, Trakya University, Edirne, Turkey
| | - Tuncay Tas
- İstanbul Cerrahi Hospital Department of Urology, Esenyurt University, İstanbul, Turkey
| |
Collapse
|
5
|
Akyüz O, Bodakçi MN, Tefekli AH. Thermal cautery-assisted circumcision and principles of its use to decrease complication rates. J Pediatr Urol 2019; 15:186.e1-186.e8. [PMID: 30770302 DOI: 10.1016/j.jpurol.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/07/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Circumcision is one of the most frequently applied surgical procedures all over the world and a number of techniques and devices have been described concerning its method. Especially in developing countries where circumcision has been performed intensively under local anaesthesia, the thermocautery device developed to perform circumcisions in a short time and safely has found a widespread application. OBJECTIVE We aim to share our experiences concerning application principles of the thermocautery device so as to be able to achieve better cosmetic results with lower complication rates. MATERIALS AND METHODS Between the years 2009 and 2016, a total of 12,355 children between the ages of 40 days and 16 years (mean: 5.1 ± 2.0 years) were circumcised at our hospital. All circumcisions were performed by urologists under local anaesthesia using a thermocautery device (Thermo-Med TM 802B device; Thermo Medikal, Adana, Turkey). RESULTS Bleeding that required surgical intervention did not occur in any patient. Compressive dressing was applied to 62 patients who had moderate degrees of bleeding, for haemostasis purposes. Twelve syncopes and four epileptic seizures developed secondary to local anaesthesia were managed in consultation with the Department of Children Health and Diseases. The most serious complication, trapped penis, was seen in 48 patients. All these complications were resolved using surgical interventions. Infection developed in 15 patients, and it was relieved with the administration of oral antibiotherapy. Penile adhesions were relieved in 25 cases, and anti-inflammatory treatment was organised. Meatal stenosis occurred in three cases, and two cases of inclusion cysts were treated with surgical intervention. DISCUSSION In countries where circumcision is routinely applied, developing swift and safer methods are of the utmost importance. To this end, we prefer thermocautery, which can satisfy patient demands swiftly and safely. CONCLUSION To reduce the complications after circumcision using thermocautery, we think that it is appropriate to pay attention to the following issues during circumcision: The cautery should be turned in a serial manner and both sides of the blade should be used for cutting, and temperature of the thermocauter should be adjusted according to the skin thickness. The cutting process should be achieved in two steps, and another method should be preferred for buried penis. If these rules are followed, we think that the thermocautery-supported method can be a very safe and fast circumcision method.
Collapse
Affiliation(s)
- O Akyüz
- Medicine Hospital Department of Urology, Biruni University, İstanbul, Turkey.
| | - M N Bodakçi
- Medicine Hospital Department of Urology, Biruni University, İstanbul, Turkey
| | - A H Tefekli
- Medicine Hospital Department of Urology, Biruni University, İstanbul, Turkey
| |
Collapse
|
6
|
Tuncer AA, Erten EEA. Examination of short and long term complications of thermocautery, plastic clamping, and surgical circumcision techniques. Pak J Med Sci 2017; 33:1418-1423. [PMID: 29492070 PMCID: PMC5768836 DOI: 10.12669/pjms.336.13640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: In this study, thermocautery, plastic clamping, and conventional (open surgical) circumcision techniques were compared in terms of their complications. Methods: Male patients who underwent circumcisions between May 2014 and May 2015 in two separate pediatric surgery clinics were retrospectively analyzed using the hospital registry system. These patients were evaluated in terms of age, accompanying pathologies, anesthesia techniques, complication rates, duration of surgery, and circumcision techniques. A statistical analysis of the data was performed, with a P<0.05 considered to be statistically significant. Results: The patients were divided into three groups according to the circumcision method: conventional surgical circumcision (n=833), thermocautery (n=1011), and plastic clamp (n=218). Complications were observed in 21 cases (1%): bleeding (11), infection (2), trapped penis (6), meatitis (1), and scrotal injury (1). There were significantly fewer complications in the thermocautery technique when compared to the clamping and surgical circumcision techniques. The plastic clamping and thermocautery techniques were superior to a surgical circumcision in terms of the operation time. Conclusion: The thermocautery circumcision technique can be used easily in both the operating theatre and in designated circumcision rooms, with a lower complication rate, when compared to plastic clamping and surgical circumcisions.
Collapse
Affiliation(s)
- Ahmet Ali Tuncer
- Dr. Ahmet Ali Tuncer, Assistant Professor, Department of Pediatric Surgery, a.Medical Faculty, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elif Emel Ayar Erten
- Dr. Elif Emel Ayar Erten, MD, Clinic of Pediatric Surgery, Hakkari State Hospital, Hakkari, Turkey
| |
Collapse
|
7
|
Mano R, Nevo A, Sivan B, Morag R, Ben-Meir D. Post-ritual Circumcision Bleeding-Characteristics and Treatment Outcome. Urology 2017; 105:157-162. [PMID: 28389263 DOI: 10.1016/j.urology.2017.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/19/2017] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment. MATERIALS AND METHODS The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated. RESULTS An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants. CONCLUSION Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged.
Collapse
Affiliation(s)
- Roy Mano
- Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amihay Nevo
- Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bezalel Sivan
- Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Morag
- Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ben-Meir
- Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Abstract
Circumcision is one of the most common procedures performed worldwide. Bleeding is one of the most common complications following male circumcision, and to decrease the risk of bleeding, electrosurgery may be utilized. However, the use of diathermy on the penis is controversial, and there are reported complications due to the use of electrosurgery for circumcision. The aim of this review is to evaluate the utilization and relative safety of monopolar and bipolar electrosurgery for circumcision in children.
Collapse
Affiliation(s)
- Tariq Ibrahim Altokhais
- Department of Surgery, Division of Pediatric Surgery, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Fotso Kamdem A, Nerich V, Auber F, Jantchou P, Ecarnot F, Woronoff-Lemsi MC. Quality assessment of economic evaluation studies in pediatric surgery: a systematic review. J Pediatr Surg 2015; 50:659-87. [PMID: 25840083 DOI: 10.1016/j.jpedsurg.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. METHODS A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. RESULTS 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). CONCLUSION This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES.
Collapse
Affiliation(s)
- Arnaud Fotso Kamdem
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Virginie Nerich
- INSERM U645 EA-2284 IFR-133, Department of Pharmacy, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Frederic Auber
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Prévost Jantchou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, 3175, Chemin de la Côte Sainte-Catherine, H3T 1C5, Montréal, Quebec, Canada.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besançon, France.
| | - Marie-Christine Woronoff-Lemsi
- UMR-INSERM-1098, Department of Clinical Research and Innovation, Besançon University Hospital, 2 place Saint Jacques, F-25000 Besançon, France.
| |
Collapse
|
10
|
Kearney S, Sharathkumar A, Rodriguez V, Chitlur M, Valentino L, Boggio L, Gill J. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers. Haemophilia 2014; 21:52-7. [DOI: 10.1111/hae.12528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 01/20/2023]
Affiliation(s)
- S. Kearney
- Children's Hospitals and Clinics of Minnesota; Pediatric Hematology Oncology; Minneapolis MN USA
| | - A. Sharathkumar
- Lurie Children's Hospital; Pediatric Hematology Oncology; Chicago IL USA
| | - V. Rodriguez
- Mayo Clinic; Pediatric Hematology Oncology; Rochester MN USA
| | - M. Chitlur
- Children's Hospital of Michigan; Pediatric Hematology Oncology; Detroit MI USA
| | - L. Valentino
- Rush University; Pediatric Hematology Oncology; Chicago IL USA
| | - L. Boggio
- Rush University; Pediatric Hematology Oncology; Chicago IL USA
| | - J. Gill
- Children's Hospital of Wisconsin; Pediatric Hematology Oncology; Milwaulkee WI USA
| |
Collapse
|
11
|
Surgical interventions in childhood rare factor deficiencies: a single-center experience from Turkey. Blood Coagul Fibrinolysis 2013; 24:854-61. [PMID: 24158119 DOI: 10.1097/mbc.0b013e3283655667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital rare factor deficiencies may present in infancy by life-threatening bleedings or may not show any symptoms until adulthood. It is reported more commonly in countries having consanguineous marriages. Data regarding surgical interventions of rare congenital factor deficiencies are based on case reports and records of guidelines. There are no well documented and separately prepared directories related to pre-surgical and prophylactic approaches of surgical interventions of these deficiencies. Our retrospective study consisted of 171 rare factor deficiencies that were followed up in our clinic, and of whom 61 had 88 surgical interventions between 1990 and 2012. Of these patients, 45 were having factor VII deficiency, and factor V, X, XI, XIII and fibrinogen deficiencies were present in five, four, three, two and two patients, respectively. In 23 patients, factor coagulant activities were under 5% (37.7%), in 15 it was between 5 and 30% (24.6%), and in 23 between 30 and 50% (37.7%). Twenty-eight were symptomatic and 33 were asymptomatic. Information of 51 (83.6%) male and 10 (16.4%) female patients with an age range of 5-25 years (13 ± 5.27), whose age at presentation ranged between 3 weeks and 18 years (7 ± 4.66), were retrieved from patient records and from the records contained in the data-processing environment introduced in 2005. The rate of familial consanguinity was 49.2%. Of the surgical interventions, 24 (27.3%) were major, 24 (27.3%) were minor and 40 (45.4%) were circumcision. We used fresh frozen plasma in 32, recombinant factor (rF)VIIa in 20, prothrombin complex concentrate in five and fibrinogen in three patients during surgical interventions. In 18 patients, antifibrinolytic agents were also used. In 27 patients, surgical interventions were applied without any replacement therapy. No additional doses were required after surgical prophylaxis doses. Thrombotic events were not observed. Antibody occurrence was not detected in these patients. In our study, we evaluated preparation for surgical procedures, factor replacement therapy before surgical intervention and postoperative follow-up in patients with rare coagulation factor deficiency.
Collapse
|
12
|
Kalkan M, Şahin C, Yazgan H. Reply. Urology 2013. [DOI: 10.1016/j.urology.2012.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Arslan D, Kalkan M, Yazgan H, Ünüvar U, Şahin C. Collective Circumcision Performed in Sudan: Evaluation in Terms of Early Complications and Alternative Practice. Urology 2013; 81:864-7. [DOI: 10.1016/j.urology.2012.11.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
|
14
|
Circumcision in males with bleeding disorders. Mediterr J Hematol Infect Dis 2013; 5:e2013004. [PMID: 23350017 PMCID: PMC3552727 DOI: 10.4084/mjhid.2013.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/01/2012] [Indexed: 11/27/2022] Open
Abstract
Introduction Male circumcision practice is an invasive procedure that is using worldwide. It makes challenges to haemostatic system and its possible haemorrhagic side effects are more serious in bleeding individuals than normal subjects. In most cases, it can be complete controlled using infusion of appropriate amount of coagulation factors before and post circumcision. Aim We aim to documentation type of coagulation therapy and post circumcision practice haemorrhagic presentation among 463 bleeder males of both common and rare bleeding disorders in north eastern part of country. Methods We retrospectively gathered information using evaluation medical records in 3 major hospitals during last 15 years and list of patients with bleeding disorders that obtained from haemophilia center. Also a call phone established for each bleeder person to complete data and updating of them. The survey took time from Sep 2009 – Mar 2011. The designed question form included data on doing circumcision or not, types of treatment before and post the procedure and occurrence of bleeding episodes after the surgery. Results Overall among 424 cases with various common and rare bleeding disorders who had circumcised, 239 cases (56.3%) had passed the procedure with bleeding experience (indication of undiagnosed cases who underwent circumcision or inadequacy of coagulation therapy), while 185 cases (43.7%) had passed it successfully and without noticeable bleeding experience. The types of coagulation therapy in each group have been cited. Conclusion The circumcision practice in unequipped medical center for bleeder ones may make challenges for them and medical services. Also it needed supervision of expert haematologist for
Collapse
|
15
|
Elalfy MS, Elbarbary NS, Eldebeiky MS, El Danasoury AS. Risk of bleeding and inhibitor development after circumcision of previously untreated or minimally treated severe hemophilia A children. Pediatr Hematol Oncol 2012; 29:485-93. [PMID: 22866674 DOI: 10.3109/08880018.2012.704624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgery and intensive factor VIII (FVIII) replacement may be risk factors for development of inhibitors. OBJECTIVE To evaluate time and rate of inhibitor development postcircumcision over 12-month period, and to assess bleeding of children with severe hemophilia A after low-dose FVIII replacement and local hemostasis. PATIENTS AND METHODS Sixty-one previously untreated patients (PUPs) or minimally treated patients (MTPs) with severe hemophilia A less than 36 months were enrolled; 25 underwent circumcision during the 18-month enrollment period, and 36 matched patients were not circumcised. All patients were treated on demand with plasma-derived FVIII, and all were inhibitor negative at the time of enrollment. Intron 22 inversion was analyzed. A potent hemostatic agent (gelatin sponge) was applied on the site of surgery, and then dressed with gauze. Two doses of FVIII concentrate (25 U/kg) were given, 1 hour before circumcision and 1 hour before removal of dressing. The inhibitor was determined every 8 exposure days (EDs). RESULTS None of the patients had bleeding or infection, except one who had minimal transient bleeding 8 days after surgery, and was treated easily by a single dose of FVIII (50 U/kg). After a median of 16 EDs, high-titer inhibitors developed in seven patients: three patients in the circumcised group (12%) in contrast to four patients (11.1%) in the noncircumcised group. CONCLUSION Two doses factor concentrate and gelatin sponge application were generally enough to prevent bleeding after circumcision of severe hemophilia A. Circumcision and low-dose FVIII protocol were not an additional risk for development of high-titer inhibitor.
Collapse
Affiliation(s)
- Mohsen S Elalfy
- Hemophilia and Thrombosis Center, Children's Hospital, Ain Shams University, Cairo, Egypt.
| | | | | | | |
Collapse
|
16
|
Beydon L, Ecoffey C, Lienhart A, Puybasset L. Circoncision chez l’enfant : une simple question d’organisation des soins ou un enjeu éthique ? ACTA ACUST UNITED AC 2012; 31:442-6. [DOI: 10.1016/j.annfar.2012.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
|
17
|
Understanding of genetic inheritance among Xhosa-speaking caretakers of children with hemophilia. J Genet Couns 2012; 21:726-40. [PMID: 22407306 DOI: 10.1007/s10897-012-9495-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
Hemophilia A and B are X-linked recessive inherited bleeding disorders that have a profound impact on the family of affected individuals. Education is vital to enable women to appreciate the implications of being a carrier and the implications for a prospective child. Prior research has shown that cultural, socio-economic and linguistic issues in South Africa are major barriers to communication for first-language Xhosa-speakers. This exploratory study aimed to investigate the basic knowledge of genetic inheritance among this cultural group in order to promote culturally-sensitive, effective genetic counseling. Ten in-depth interviews were conducted with Xhosa-speaking mothers or caregivers of boys with hemophilia. Results suggest that the participants had a very limited understanding of the clinical management, genetic consequences and cause of hemophilia. While treatment and care by health care service providers was fully accepted, several participants believed that traditional methods would provide them with more satisfactory explanations. These findings suggest that there is a critical need for socio-culturally tailored, language-specific education for families with hemophilia.
Collapse
|
18
|
Affiliation(s)
- Rolf C. R. Ljung
- Lund University, Departments of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö; Sweden
| | - Karin Knobe
- Lund University, Departments of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö; Sweden
| |
Collapse
|
19
|
SASMAZ I, ANTMEN B, LEBLEBISATAN G, ŞAHIN KARAGÜN B, KILINÇ Y, TUNCER R. Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience. Haemophilia 2011; 18:426-30. [DOI: 10.1111/j.1365-2516.2011.02706.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
YILMAZ D, AKIN M, AY Y, BALKAN C, ÇELIK A, ERGÜN O, KAVAKLI K. A single centre experience in circumcision of haemophilia patients: Izmir protocol. Haemophilia 2010; 16:888-91. [DOI: 10.1111/j.1365-2516.2010.02324.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Méndez-Gallart R, Estévez E, Bautista A, Rodríguez P, Taboada P, Armas AL, Pradillos JM, Varela R. Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children. J Pediatr Surg 2009; 44:2048-53. [PMID: 19853772 DOI: 10.1016/j.jpedsurg.2009.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/11/2009] [Accepted: 06/01/2009] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study is to evaluate bipolar scissors circumcision by comparing it with standard freehand scalpel procedure. PATIENTS AND METHODS Data were analyzed from a prospective, randomized study, comparing 2 different surgical techniques for pediatric circumcision: the bipolar diathermy scissors circumcision technique with those of a conventional scalpel technique. A total of 230 pediatric patients younger than 16 years (115 in each arm of the trial) who were undergoing circumcision were reviewed prospectively. Operative time, surgical bleeding, complications, and postoperative morbidity were analyzed. Differences between bipolar scissors circumcision and conventional surgery were compared. RESULTS Median blood loss for bipolar circumcision was 0.2 mL (range, 0-0.8 mL) compared with 2.1 mL in the standard group (range, 0.9-4.2 mL) (P < .001). Operative time in the bipolar diathermy treated group was significantly decreased compared with conventionally treated patients (10.8 +/- 1.2 vs 19.1 +/- 2.6 minutes; P < .01). Early and late postoperative morbidity were significantly decreased in circumcised patients who underwent the bipolar circumcision technique as compared with those who underwent the conventional approach regardless of the postoperative edema (22 vs 10; P = .02). CONCLUSIONS Bipolar scissors circumcision approach is an effective and safe procedure alternative to the standard scalpel technique in pediatric circumcision with no significant morbidity.
Collapse
Affiliation(s)
- Roberto Méndez-Gallart
- Department of Pediatric Surgery, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
HERMANS C, ALTISENT C, BATOROVA A, CHAMBOST H, DE MOERLOOSE P, KARAFOULIDOU A, KLAMROTH R, RICHARDS M, WHITE B, DOLAN G. Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations. Haemophilia 2009; 15:639-58. [DOI: 10.1111/j.1365-2516.2008.01950.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Abstract
Major surgical procedures can be performed safely for hemophiliacs provided the clotting factors are adequate. However, rhinoplasty, an elective facial procedure, has not yet been evaluated in this group of patients. The authors present a hemophilia A patient who underwent rhinoplasty for cosmetic reasons.
Collapse
Affiliation(s)
- Zafer Ozsoy
- Department of Plastic and Reconstructive Surgery, Vakif Gureba Training Hospital, Vatan cad., 34093, Fatih, and Department of Pediatric Hematology, Istanbul University, Oncology Institute Gapa, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
25
|
Kavakli K, Avanoglu A, Celik A. Cost-effectivity of circumcision in hemophilia. J Pediatr Surg 2005; 40:1211-2; author reply 1212. [PMID: 16034776 DOI: 10.1016/j.jpedsurg.2005.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000172405.15632.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|