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Toprak H, Kandemir E. Comparison of the effects of ring block and dorsal penile nerve block on parental satisfaction for circumcision operation in children: randomized controlled trial. Pediatr Surg Int 2024; 40:101. [PMID: 38587622 DOI: 10.1007/s00383-024-05681-5] [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: 03/19/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In children, circumcision is a procedure associated with perioperative pain and parental satisfaction is an important parameter in the evaluation of anesthesia procedures. Inadequate dorsal penile nerve block (DPNB) for the ventral shaft of the penis might impact parental satisfaction negatively. To evaluate this hypothesis, we compared the effects of penile ring block (RB) and dorsal penile nerve block (DPNB) on parental satisfaction. Postoperative pain, need for additional analgesia, intraoperative hemodynamic data, recovery status, side effects, and postoperative complications were evaluated as secondary outcomes between the blocks. METHODS Parental satisfaction and anesthetic effectiveness of RB and DPNB for circumcision in children were compared. 86 patients were randomized 1:1 to Group RB and Group DPNB, which were administered the same dose of anesthesia. Parental satisfaction was evaluated with the Pediatric Anesthesia Parental Satisfaction Questionnaire (PAPS). Postoperative pain evaluations were made with the Face, Legs, Activity, Crying, Consolability Pain Scale (FLACC). RESULTS In terms of parent satisfaction, no differences were detected between the groups in the pre-anesthesia, pre-anesthesia and post-anesthesia, post-anesthesia, hospital team, and anesthesia team parameters (p > 0.05). The scores of Group DPNB patients were higher only in the "Q11" subparameter in the "anesthesia team" parameter, and this difference was significant (0.024). CONCLUSION RB and DPNB were compared in circumcision, which is the most common surgical procedure for children. Parental satisfaction, anesthesia, and analgesic effects of both blocks were found to be similar. CLINICAL TRIALS ACTRN12622001211752.
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Affiliation(s)
- Hatice Toprak
- Department of Anesthesiology and Reanimation, Karamanoğlu Mehmetbey University Faculty of Medicine, Yunus Emre Campus, Center, 70200, Karaman, Turkey.
| | - Emre Kandemir
- Department of Urology, Karamanoğlu Mehmetbey University Faculty of Medicine, Yunus Emre Campus, Center, 70200, Karaman, Turkey
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Zhu D, Zhu H. Efficacy of three types of circumcision for children in the treatment of phimosis: A retrospective study. Medicine (Baltimore) 2022; 101:e32198. [PMID: 36482531 PMCID: PMC9726407 DOI: 10.1097/md.0000000000032198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Phimosis is a common condition of the urinary system in children and often requires surgical treatment. However, the optimal method of circumcision for children has not been determined. Herein, we analyzed the efficacy of 3 circumcision methods for children with phimosis. A retrospective analysis of 112 cases of pediatric phimosis after circumcision was conducted at our hospital. Among them, 36 cases were subjected to conventional operation (group A), 43 cases to ring circumcision (group B), and 33 cases to suturing device circumcision (group C). The duration of operation, amount of bleeding, pain, complications, healing time, and the satisfaction of the guardians were calculated. The operation time of group B and C was (6.26 ± 1.31) min and (7.67 ± 1.29) min, respectively, which was shorter than group A (27.42 ± 2.42) min (P < .05); besides, group A had the most blood loss volume, (9.67 ± 1.67) mL, and group B was the least (1.26 ± 0.44) mL (P < .05); group B had the strongest postoperative pain (4.05 ± 0.37), the longest pain time (6.84 ± 1.29) days, and the longest healing time (21.84 ± 4.23) days (P < .05). Postoperative complications were lowest in group C (11.11% vs 20.93% vs 6.06%), satisfaction of guardians was highest in group C (86.11% vs 85.27% vs 89.99%), but the difference was not statistically significant (P > .05). Three types of surgical procedures present with advantages and disadvantages. The conventional surgery led to longer operation time and more bleeding but did not require special medical equipment and was easy to carry out; ring surgery had the shortest operation time, the least bleeding, accompanied by the longest recovery time and pain duration; the complications of the suturing device were the least, the parents had the highest degree of satisfaction, however, it also needs a specific suturing device. Therefore, each type had its distinctive characteristics and may be flexibly selected based on their own conditions.
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Affiliation(s)
- Dongsheng Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Haizhou District, Lianyungang, P.R. China
- * Correspondence: Dongsheng Zhu, Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, No.182, North Tongguan Road, Haizhou District, Lianyungang 222000, P.R. China (e-mail: )
| | - Hongqi Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Haizhou District, Lianyungang, P.R. China
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Voluntary Medical Male Circumcision for HIV Prevention: a Global Overview. Curr HIV/AIDS Rep 2022; 19:474-483. [PMID: 36348186 DOI: 10.1007/s11904-022-00632-y] [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] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW With the promise of HIV prevention, there has been a scale-up of voluntary medical male circumcision (VMMC) in high HIV incidence/low circumcision prevalence nations worldwide. Nonetheless, debates over the implementation and the effectiveness and safety of the VMMC in real-world settings persist. We revisit the role of VMMC in HIV prevention to inform health professionals, policymakers, and advocates or opponents in this new era. RECENT FINDINGS There has been substantial progress on VMMC scale-up to date, but this has varied considerably by region. The evidence of solid and direct protection of VMMC is available for heterosexual men and older adolescent boys in sub-Saharan Africa. The protective effect in men who have sex with men is suggested by systematic reviews but is not confirmed by clinical trials. Sexual partners, including women, likely benefit indirectly from the increased VMMC coverage through a decreased risk of exposure to infected male partners. Fortunately, the preponderance of studies does not suggest higher sexual risk behaviors among circumcised men, so-called risk compensation. VMMC requires health systems strengthening and continued promulgation of other evidence-based HIV prevention strategies to be successful. Health authorities in high HIV incidence areas that have low circumcision coverage should implement VMMC within a context of complementary biomedical and behavioral prevention strategies.
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Uberoi M, Abdulcadir J, Ohl DA, Santiago JE, Rana GK, Anderson FWJ. Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum. Int J Impot Res 2022; 35:234-241. [PMID: 36274189 DOI: 10.1038/s41443-022-00619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
The removal of non-pathogenic foreskin from the penis of healthy neonates and infants for non-religious reasons is routinely practiced in many parts of the world. High level data from well-designed randomized controlled trials of circumcision in neonates and infants does not guide clinical practice. Reliable counts of immediate and short term circumcision complications are difficult to estimate. Emerging evidence suggests routine neonatal circumcision could lead to long term psychological, physical, and sexual complications in some men. The stigma associated with discussing circumcision complications creates a prevalence paradox where the presence of significant circumcision complications is higher than reported. Prior to the Internet, there were very few forums for men from diverse communities, who were troubled about their circumcision status, to discuss and compare stories. To investigate the long term consequences of circumcision, we reviewed 135 posts from 109 individual users participating in a circumcision grief subsection of Reddit, an internet discussion board. We identified three major categories of complications: physical such as pain during erections and lost sensitivity, psychological such as anxiety and violation of autonomy, and sexual such as feeling that the sexual experience was negatively altered or being unable to complete a sexual experience. We also identified a "discovery process" where some men described coming into awareness of their circumcision status. These findings suggest that neonatal circumcision can have significant adverse consequences for adult men. The removal of normal foreskin tissue should be limited to adult men who choose the procedure for cosmetic reasons or when medically indicated.
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Nabavizadeh B, Li KD, Hakam N, Shaw NM, Leapman MS, Breyer BN. Incidence of circumcision among insured adults in the United States. PLoS One 2022; 17:e0275207. [PMID: 36251658 PMCID: PMC9576047 DOI: 10.1371/journal.pone.0275207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States. Methods Using IBM MarketScan® Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes. Results We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (±12.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (Δ+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine/ritual circumcision (28.7%), phimosis + balanitis/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups. Conclusion This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | - Kevin D. Li
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan M. Shaw
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Bowa K, Rodriguez VJ, Malik FS, Knight J, Cristofari N, Parrish MS, Jones DL, Zulu R, Weiss SM. Dissemination of the Spear & Shield Project using a Training of Trainers Model: A reflection on challenges and successes. Transl Behav Med 2022; 12:622-629. [PMID: 35312766 PMCID: PMC9154251 DOI: 10.1093/tbm/ibac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several large-scale clinical trials have conclusively demonstrated that voluntary medical male circumcision (VMMC) could provide a 50%-70% reduction in HIV acquisition, but willingness to undergo VMMC has been lowest in Zambia compared to other countries in eastern and southern Africa. This manuscript describes training for "task-shifting" among local healthcare workers at Community Health Centers (CHCs) applying state of the art strategies (e.g., Training of Trainers, i.e., ToT, and Training of Facilitators, ToF) to provide novel clinical services. Staff at 96 CHCs from four Provinces in Zambia were sequentially trained to provide the Spear & Shield intervention. A total of 45,630 men (n = 23,236) and women (n = 22,394) volunteered to participate in the S&S intervention service program when offered in the CHCs. Group session (total = 5313 sessions; 2,736 men's and 2,582 women's sessions) were conducted over 4.5 years. Remarkably, both men and women's groups achieved 97% retention. Of these, 256 sessions recorded from 128 group leaders were assessed and scored for intervention fidelity; fidelity was 80%-90% among the majority of clinics. S&S program sustainment exceeded expectations among 85% of clinics (82/96) in all provinces across the duration of the study. Of note, attendance in the S&S program was encouraged by CHC staff, but no financial incentives were provided to those attending S&S. This study examined the effectiveness of the ToT/ToF model in dissemination of the S&S program, which proved to be feasible even in resource-limited settings. Benefits and challenges are discussed.
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Affiliation(s)
- Kasonde Bowa
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Violeta J Rodriguez
- Department of Psychology, University of Georgia, Athens, GA,USA
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fayeza S Malik
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jennifer Knight
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Nicholas Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manasi S Parrish
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence to: DL Jones,
| | - Robert Zulu
- Ministry of Health, Provincial Health Office, Ndola, Copperbelt,Zambia
- Department of Health Promotion and Education, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Nicassio L, Klamer B, Fuchs M, McLeod DJ, Alpert S, Jayanthi R, DaJusta D, Ching CB. Broadening candidate office circumcision patients: A comparison of outcome in children based on age and weight. J Pediatr Urol 2022; 18:91.e1-91.e6. [PMID: 34911665 DOI: 10.1016/j.jpurol.2021.11.003] [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: 02/19/2021] [Revised: 10/12/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Office circumcision with a clamp or Plastibell device is often restricted in practice by patient age and size. This is thought to ensure the patient fits appropriately on the restraining device and limit complications. OBJECTIVE To compare the outcomes of office circumcision in children ≤3 months of age and ≤5.1 kg in weight to those who do not fit this criterion. STUDY DESIGN A retrospective chart review was performed of all office circumcisions in children ≤6 months of age performed in our urology clinic between January 2015-August 2018. Patients were divided into two groups: Group 1 (≤3 months old and ≤5.1 kg) and Group 2 (all others). Patient demographics and circumcision technique were recorded. The number of patients with complications and requiring an intervention related to circumcision were compared between groups, as well as the number of patients requiring unplanned hospital visits. Differences in outcomes were evaluated using Pearson's chi-square test. RESULTS A total of 205 circumcisions were performed in Group 1 and 498 circumcisions were performed in Group 2. All circumcisions were performed by either Gomco clamp or Plastibell device with no significant difference in method between groups (p = 0.5). There was no difference in median follow-up between groups (Group 1: 19 days [IQR 14; 34]; Group 2: 19 days [IQR 14; 36]; p = 0.6). There were no significant differences between groups in the number patients with complications or requiring an intervention (p = 0.08 and p = 0.12, respectively). Significantly more patients in Group 2 required an unplanned hospital visit (p = 0.02) (Table). After categorizing those composing Group 2 into three disjoint sets (children >3 months and ≤5.1 kg, or ≤3 months and >5.1 kg, or >3 months and >5.1 kg), no significant difference across all four groups in regards to complications (p = 0.12) or intervention (p = 0.2) was found. There was a significant difference in unplanned hospital visits (p < 0.001). DISCUSSION Performing office circumcisions in children outside of age and weight restrictions of ≤3 months and ≤5.1 kg did not significantly increase the risk of complications or need for interventions. Those outside of age and weight restrictions, however, had more unplanned hospital visits. Tailoring parent expectations in this patient group may be needed. CONCLUSIONS While we found older and heavier children had more unplanned post-procedural related hospital visits, their rates of overall complications and need for subsequent interventions were not significantly higher than younger and lighter children.
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Affiliation(s)
- Lauren Nicassio
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brett Klamer
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA; Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly Fuchs
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daryl J McLeod
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research, Department of Pediatric Surgery, Nationwide, USA
| | - Seth Alpert
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rama Jayanthi
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel DaJusta
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina B Ching
- Department of Pediatric Urology, Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Ben Amar W, Siala H, Zribi M, Karray N, Dhouib H, Hammami Z, Maatoug S. [Medico-legal issues of the practice of ritual circumcision by nurses in Tunisia]. REVUE DE L'INFIRMIERE 2022; 71:33-36. [PMID: 35184857 DOI: 10.1016/j.revinf.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Circumcision is the most performed surgical procedure in the world. This removal of the foreskin answers most often to an obligatory ritual practice in the Jewish and Muslim religions. In Tunisia, this act, formerly practiced by customary circumcisers, is mainly performed by nurses. In case of complications, the responsibility of the latter remains unclear, in the absence of regulations specific to this ancestral practice, with the exception of two ministerial circulars.
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Affiliation(s)
- Wiem Ben Amar
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
| | - Hela Siala
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie.
| | - Malek Zribi
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
| | - Narjes Karray
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
| | - Hanen Dhouib
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
| | - Zouhir Hammami
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
| | - Samir Maatoug
- Service de médecine légale, hôpital Habib-Bourguiba, rue Al-Firdaws, 3029 Sfax, Tunisie
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Comparison of NeoAlis™ disposable circumcision device and sleeve technique in circumcision: Results from a referral health-care center in Turkey. J Pediatr Urol 2021; 17:856.e1-856.e10. [PMID: 34696964 DOI: 10.1016/j.jpurol.2021.09.019] [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: 05/28/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Circumcision has been one of the most commonly performed surgical procedures worldwide since ancient times. Given the popularity of this procedure, the aim of this study was to evaluate the effectiveness, reliability, and results of circumcision performed using the NeoAlis™ clamp and compare them with those obtained using the sleeve technique. STUDY DESIGN The results of 2259 patients circumcised using the two techniques were evaluated retrospectively. The patients who were circumcised using the plastic NeoAlis™ device were classified as group 1 and those circumcised using the sleeve technique were designated as group 2. The groups were compared in terms of operation time, results, cost, complications, and cosmetic satisfaction scores. RESULTS A total of 1947 patients who met the inclusion criteria were included in the study. Group 1 consisted of 1454 patients, while group 2 comprised 493 patients. The total rate of complications, excluding bleeding in the form of oozing that stopped spontaneously, was 9.5% (n = 185). In group 1, the operation time was shorter, tolerability of local anesthesia was higher, satisfaction questionnaire scores were higher, cost was lower, and rates of early adhesion and meatal stenosis were lower. All of these parameters were significantly different from those in group 2. Notably, secondary phimosis was significantly higher in group 1. Although the bleeding that stopped with follow-up was significantly higher in group 2, there was no significant difference between the groups in terms of bleeding that required surgical intervention. DISCUSSION Our study, which reports the results of circumcisions performed using the NeoAlis clamp, has the largest sample size in the literature. Moreover, this is the only study in the literature wherein the results of sleeve circumcision, which is a time-tested surgical procedure, and the results of NeoAlis clamp circumcision, which we applied to a large number of patients, were compared with each other and with the literature. The retrospective design that focused on relatively short-term (one month) results is the major limitation of this study. CONCLUSION Mass circumcision performed with a plastic clamp technique is safe, timesaving, easily teachable, and cosmetically advantageous.
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Hohlfeld ASJ, Ebrahim S, Zaki Shaik M, Kredo T. Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: a Cochrane review. BJU Int 2021; 130:26-34. [PMID: 34587354 PMCID: PMC9297972 DOI: 10.1111/bju.15604] [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: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above). METHODS We performed a comprehensive search with no restrictions to the language of publication or publication status. We included randomised controlled trials (RCTs) of device-based circumcisions compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting. We reported study results as risk ratios (RRs) or mean differences (MDs) using 95% confidence intervals (CIs) and a random-effects model. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the overall certainty of the evidence for each outcome. RESULTS A total of 18 trials met the inclusion criteria. These trials did not report severe adverse events (AEs; 11 trials, 3472 participants). There may be a slight increase in moderate AEs for devices compared to surgical techniques (RR 1.31, 95% CI 0.55-3.10; I2 = 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to eight more (ranging from 15 fewer to 84 more) moderate AEs per 1000 participants. We are uncertain about the difference in mild AEs between groups when devices are used compared to surgical techniques (RR 1.09, 95% CI 0.44-2.72; I2 = 91%; 10 trials, 3370 participants; very low-certainty evidence). CONCLUSIONS We found no serious AEs using a circumcision device compared to surgical techniques. Still, they may slightly increase moderate AEs, and it is unclear whether there is a difference in mild AEs. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of AEs. Clinicians, patients, and policymakers can use these results combined with their contextual factors to inform the best approach that suits their healthcare settings.
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Affiliation(s)
| | - Sumayyah Ebrahim
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Muhammed Zaki Shaik
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Clinical Pharmacology Division, Department of Medicine, Stellenbosch University, Cape Town, South Africa
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Circumcision as an Intervening Strategy against HIV Acquisition in the Male Genital Tract. Pathogens 2021; 10:pathogens10070806. [PMID: 34201976 PMCID: PMC8308621 DOI: 10.3390/pathogens10070806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
Unsafe sex with HIV-infected individuals remains a major route for HIV transmission, and protective strategies, such as the distribution of free condoms and pre-or post-prophylaxis medication, have failed to control the spread of HIV, particularly in resource-limited settings and high HIV prevalence areas. An additional key strategy for HIV prevention is voluntary male circumcision (MC). International health organizations (e.g., the World Health Organization, UNAIDS) have recommended this strategy on a larger scale, however, there is a general lack of public understanding about how MC effectively protects against HIV infection. This review aims to discuss the acquisition of HIV through the male genital tract and explain how and why circumcised men are more protected from HIV infection during sexual activity than uncircumcised men who are at higher risk of HIV acquisition.
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Hohlfeld A, Ebrahim S, Shaik MZ, Kredo T. Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions. Cochrane Database Syst Rev 2021; 3:CD012250. [PMID: 33786810 PMCID: PMC8095026 DOI: 10.1002/14651858.cd012250.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medical circumcisions are among the most common surgical procedures performed in males. The usual indications are phimosis (inability to completely retract the foreskin and expose the glans due to a congenital or acquired constriction of the prepuce), paraphimosis (when the foreskin is not pulled back over the glans after retraction resulting in a tight constricting band which causes swelling of the distal penis and acute discomfort), balanoposthitis (erythema and edema of the prepuce and glans) and balanitis (inflammation is confined to the glans; the foreskin is usually non-retractile). Circumcision devices have been developed to shorten the operative time, simplify techniques, and improve safety and cosmetic outcomes. The devices generally aim to crush the foreskin while simultaneously creating hemostasis, the foreskin is then excised or allowed to slough off. Their use is supposedly safer and easier to replicate than the standard dissection techniques. There are at least 20 devices for male circumcision on the market, yet their effectiveness has not been reviewed to date. OBJECTIVES To assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above). SEARCH METHODS We performed a comprehensive search with no restrictions to the language of publication or publication status. We searched the Cochrane Library, MEDLINE (PubMed), Embase, Web of Science, trials registries, grey literature sources and conference proceedings up to 16 April 2020. SELECTION CRITERIA We included randomized controlled trials of device-based circumcisions (crush or ligature circumcision devices) compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and extracted data from the included studies. We classified adverse events into serious, moderate or mild. We reported study results as risk ratios (RR) or mean differences (MD) using 95% confidence intervals (CI) and a random-effects model. We used the GRADE approach to evaluate the overall certainty of the evidence for each outcome. MAIN RESULTS Eighteen trials met the inclusion criteria. Trials were conducted in China, South Africa, Kenya and Zambia, Mozambique, Rwanda, Uganda and Zimbabwe. Primary outcomes Serious adverse events: there were no serious adverse events in either treatment arm (11 trials, 3472 participants). Moderate adverse events: there may be a slight increase in moderate adverse events when devices are used compared to standard surgical techniques (RR 1.31, 95% CI 0.55 to 3.10; I²= 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to 8 more (ranging from 15 fewer to 84 more) moderate adverse events per 1000 participants. We downgraded the certainty of the evidence for study limitations and imprecision. Secondary outcomes Mild adverse events: we are uncertain about the difference in mild adverse events between groups when devices are used compared to standard surgical techniques (RR 1.09, 95% CI 0.44 to 2.72; I² = 91%; 10 trials, 3370 participants; very low-certainty evidence). We downgraded the certainty of the evidence for study limitations, imprecision and unexplained inconsistency. Operative time: operative time is probably about 17 minutes shorter when using a device rather than standard surgical techniques, which constitutes a clinically meaningful decrease in a procedure (MD -17.26 minutes, 95% CI -19.96 to -14.57; I² = 99%; 14 trials, 4812 participants; moderate-certainty evidence). We downgraded the certainty of the evidence for serious study limitations. The standard surgical technique generally takes about 24 minutes. There may be less postoperative pain during the first 24 hours when circumcision devices are used compared to standard surgical techniques (measured using a visual analog scale [VAS]; MD 1.30 cm lower, 95% CI 2.37 lower to 0.22 lower; I² = 99%; 9 trials, 3022 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained heterogeneity. There may be little or no difference in postoperative pain experienced during the first seven days when compared with standard surgical techniques (measured using a VAS; MD 0.11 cm higher, 95% CI 0.89 lower to 1.11 higher; I² = 94%; 4 trials, 1430 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. A higher score on the VAS indicates greater pain. Participants may slightly prefer circumcision devices compared to standard surgical techniques (RR 1.19, 95% CI 1.04 to 1.37; I² = 97%; 15 trials, 4501 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. We recorded satisfaction as a dichotomous outcome. Higher rates reflected greater satisfaction. AUTHORS' CONCLUSIONS We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and policymakers can use these results in conjunction with their own contextual factors to inform the approach that best suits their healthcare settings. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of adverse effects and postoperative pain of using devices compared to standard approaches.
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Affiliation(s)
- Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- School of Clinical Medicine, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Muhammed Zaki Shaik
- School of Clinical Medicine, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Nicassio L, Ching CB, Klamer B, Sebastião YV, Fuchs M, McLeod DJ, Alpert S, Jayanthi R, DaJusta D. Gomco vs. plastibell office circumcision: No difference in overall post-procedural complications and healthcare utilization. J Pediatr Urol 2021; 17:85.e1-85.e7. [PMID: 33281046 DOI: 10.1016/j.jpurol.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Gomco clamp and Plastibell ring are common methods of office circumcision. While they possess similar features, the Plastibell is retained after the procedure which could impact perceived and true outcomes of the procedure. OBJECTIVE This study evaluated differences in complications, interventions, and healthcare utilization between Gomco and Plastibell office circumcision techniques. STUDY DESIGN We retrospectively reviewed urology office performed circumcisions (January 2015-August 2018), limiting analysis to patients with follow-up. Patient demographics and circumcision technique were recorded. Complications, interventions, phone calls, emergency department (ED)/urgent care (UC) visits, and unplanned office visits directly related to the circumcision were recorded. Descriptive statistics for the number of patients experiencing an event and the number of days to event were summarized. Survival analysis with inverse probability of treatment weights was used to estimate hazard and incidence rate ratios (HR and IRR, respectively). RESULTS 746 patients were included for analysis. Median time of follow-up was 2.7 weeks (interquartile range 2-5). 257 (34%) patients underwent Gomco circumcision; 489 (66%) underwent Plastibell circumcision. The techniques did not significantly differ for complications (HR = 0.9, p = 0.497), interventions (HR = 0.89, p = 0.498), and hospital visits (HR = 1.0, p = 0.985) (Table), although Plastibell patients presented to the ED/UC more (odds ratio = 1.6, p = 0.02). Plastibell patients generated proportionally more post-procedural phone calls (63 vs. 52%), though not significantly (IRR = 1.11; p = 0.426). DISCUSSION Overall, the type of device used for office circumcision, between Gomco clamp and Plastibell ring, does not appear to impact the outcome of circumcision. Providers should perform the method of office circumcision with which they are familiar and comfortable. There is an overall reliance on healthcare resources suggesting poor family preparation of the post-procedural course regardless of the technique, necessitating better patient education. Limitations of this study include its retrospective nature, variability in follow-up between techniques, and variety of providers, limited to pediatric urologists, performing circumcision. CONCLUSIONS Gomco and Plastibell office circumcision techniques do not significantly differ in post-procedural complications, interventions, unplanned hospital visits, and office phone calls. Plastibell patients do present more often to the ED/UC perhaps as a result of increased anxiety and perceived immediacy of concerns with the device.
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Affiliation(s)
- Lauren Nicassio
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus OH, USA.
| | - Brett Klamer
- Biostatistics Resource at Nationwide Children's Hospital, Columbus OH, USA; Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus OH, USA
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus OH, USA
| | - Molly Fuchs
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA
| | - Daryl J McLeod
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA; Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus OH, USA
| | - Seth Alpert
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA
| | - Rama Jayanthi
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA
| | - Daniel DaJusta
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA
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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.
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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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Ogundoyin OO, Olulana DI, Lawal TA, Kumolalo FO. Comparing pain control using oral acetaminophen versus dorsal penile block in neonatal circumcision. ANNALS OF PEDIATRIC SURGERY 2019. [DOI: 10.1186/s43159-019-0002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Circumcision is one of the commonest surgical procedures performed yet the most controversial worldwide. Although various reasons have been suggested in support of circumcision, the pain and stress that accompany it on both neonates and mothers are factors against the procedure. This study compared pain control using oral acetaminophen syrup versus 1% lidocaine injection given as dorsal penile block during neonatal circumcision.
Results
There were 191 neonates in group A and 195 in group B. The mean age at circumcision was 23.71 (SD ± 20.39) days, and mean weight was 3.33 (SD ± 0.74) kg. The mean pain scores for group A immediately and 1 h after circumcision were 4.26 (SD ± 2.48) and 0.37 (SD ± 1.35), respectively. In group B, the mean pain scores immediately and 1 h after circumcision were 3.31 (SD ± 2.59) and 0.35 (SD ± 1.19), respectively.
Conclusion
Penile block gives better pain control in comparison with oral acetaminophen syrup, but both agents are effective and can be combined to provide a long-lasting perioperative anaesthesia and analgesia for circumcision in the hospital setting.
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Olapade-Olaopa EO, Salami MA, Lawal TA. Male circumcision and global HIV/AIDS epidemic challenges. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0005-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Given the devastating mortality and morbidity associated with HIV/AIDS, many potential prevention measures against HIV infection continue to be explored. Most prevention methods are in the realm of sexual behavior change. However, of all aspects of human behavior, it is sexual behavior that is least amenable to change. Newer and simpler interventions are therefore required. Male circumcision, the surgical removal of some or all of the foreskin (or prepuce) from the penis, is one of the ways being promoted as a preventive measure. This paper reviews the scientific basis and evidence for the efficacy of male circumcision within the context of the global challenges involved.
Main body
We reviewed articles with emphasis on male circumcision and HIV/AIDS transmission. Published abstracts of presentations at international scientific meetings were also reviewed.
Conclusions
Current epidemiological evidence supports the promotion of male circumcision for HIV prevention, especially in populations with high HIV prevalence and low circumcision rates. Three notable randomized control trials strengthen the case for applied research studies to demonstrate that safe male circumcision is protective at the population level, particularly as ideal and well-resourced conditions of a randomized trial are often not replicated in other service delivery settings. Ethically and culturally responsive strategies in promoting circumcision in a culturally heterogenous world need to be developed, too. Male circumcision should also be viewed as a complementary measure along with other proven approaches to turn the HIV/AIDS epidemic around.
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Harris VC, Links AR, Walsh J, Schoo DP, Lee AH, Tunkel DE, Boss EF. A Systematic Review of Race/Ethnicity and Parental Treatment Decision-Making. Clin Pediatr (Phila) 2018; 57:1453-1464. [PMID: 30014706 PMCID: PMC6460468 DOI: 10.1177/0009922818788307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient race/ethnicity affects health care utilization, provider trust, and treatment choice. It is uncertain how these influences affect pediatric care. We performed a systematic review (PubMed, Scopus, Web of Science, PsycINFO, Cochrane, and Embase) for articles examining race/ethnicity and parental treatment decision-making, adhering to PRISMA methodology. A total of 9200 studies were identified, and 17 met inclusion criteria. Studies focused on treatment decisions concerning end-of-life care, human papillomavirus vaccination, urological surgery, medication regimens, and dental care. Findings were not uniform between studies; however, pooled results showed (1) racial/ethnic minorities tended to prefer more aggressive end-of-life care; (2) familial tradition of neonatal circumcision influenced the decision to circumcise; and (3) non-Hispanic Whites were less likely to pursue human papillomavirus vaccination but more likely to complete the vaccine series if initiated. The paucity of studies precluded overarching findings regarding the influence of race/ethnicity on parental treatment decisions. Further investigation may improve family-centered communication, parent engagement, and shared decision-making.
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Affiliation(s)
- Vandra C. Harris
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Anne R. Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Desi P. Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andrew H. Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David E. Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland,Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Prospective comparison of two models of integrating early infant male circumcision with maternal child health services in Kenya: The Mtoto Msafi Mbili Study. PLoS One 2017; 12:e0184170. [PMID: 28880904 PMCID: PMC5589171 DOI: 10.1371/journal.pone.0184170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/18/2017] [Indexed: 11/30/2022] Open
Abstract
As countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). To address the lack of evidence regarding introduction of EIMC services in sub-Saharan African settings, we conducted a simultaneous, prospective comparison of two models of EIMC service delivery in Homa Bay County, Kenya. In one division a standard delivery package (SDP) was introduced and included health facility-based provision of EIMC services with community engagement for client referral versus in a different division a standard package plus (SDPplus) that included community-delivered EIMC services. Babies 1–60 days old were eligible for EIMC. A representative sample of mothers and fathers of baby boys at 16 health facilities was surveyed. We examined differences between mothers and fathers in the SDP and SDPplus divisions and identified factors associated with EIMC uptake. We report adjusted prevalence ratios (aPR). Of 1660 mothers interviewed, 1501 (89%) gave approval to contact the father, and 1259 fathers (84%) were interviewed. The proportion of babies circumcised was slightly greater in the SDPplus division than the SDP division (27.3% vs 23.7%), but the difference was not significant (p = 0.08). In adjusted analyses, however, the prevalence of babies being circumcised was greater in the SDPplus division (aPR = 1.23, 95% CI:1.04–1.45) and the factors associated with a baby being circumcised were the mother having received information about EIMC (during pregnancy, aPR = 4.81, 95% CI: 2.21–3.42), having discussed circumcision with the father if married or cohabiting (aPR = 5.39, 95% CI: 3.31–8.80) or being single (aPR = 5.67, 95% CI: 3.31–9.69), perceiving herself to be living with HIV (aPR = 1.39, 95% CI: 1.15–1.67), or having a post-secondary education (aPR = 1.33, 95% CI: 1.04–1.69), and the father being Muslim (aPR = 1.85, 95% CI: 1.29–2.65) or circumcised (aPR = 1.34, 95% CI: 1.13–1.59). The median age of 2117 babies circumcised was 8 days (IQR: 1–36), and the median weight was 3.6 kg (IQR: 3.2–4.4). There were 6 moderate adverse events (AEs) (0.28%); 5 severe AEs (0.24%), all involving an injury to the glans penis, requiring hospitalization and corrective surgery; and one death probably related to the procedure. There were no AEs among the 365 procedures performed outside health facilities. Information and education campaigns must reach members of the general population, especially men and fathers, who are influential to the EIMC decision. Serious AEs using the Mogen clamp are rare, but do occur and require efficient, reliable emergency back-up. Our results can assist countries considering scale-up of EIMC services for HIV prevention as their adult VMMC programs mature.
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Gyan T, McAuley K, Strobel N, Newton S, Owusu-Agyei S, Edmond K. The influence of socioeconomic factors on choice of infant male circumcision provider in rural Ghana; a community level population based study. BMC Pediatr 2017; 17:185. [PMID: 28851410 PMCID: PMC5576234 DOI: 10.1186/s12887-017-0937-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/23/2017] [Indexed: 12/01/2022] Open
Abstract
Background The influence of socio-economic determinants on choice of infant male circumcision provider is not known in areas with high population coverage such as rural Africa. The overall aim of this study was to determine the key socio-economic factors which influence the choice of infant male circumcision provider in rural Ghana. Methods The study investigated the effect of family income, distance to health facility, and cost of the circumcision on choice of infant male circumcision provider in rural Ghana. Data from 2847 circumcised infant males aged under 12 weeks and their families were analysed in a population-based cross-sectional study conducted from May to December 2012 in rural Ghana. Multivariable logistic regression models were adjusted for income status, distance to health facility, cost of circumcision, religion, maternal education, and maternal age. Results Infants from the lowest income households (325, 84.0%) were more likely to receive circumcision from an informal provider compared to infants from the highest income households (260, 42.4%) even after adjusting for religious affiliation (adjusted odds ratio [aOR] 4.42, 95% CI 3.12–6.27 p = <0.001). There appeared to be a dose response with increasing risk of receiving a circumcision from an informal provider as distance to a health facility increased (aOR 1.25, 95 CI 1.30–1.38 P = <0.001). Only 9.0% (34) of families in the lowest socio-economic quintile received free circumcision services compared to 27.9% (171) of the highest income families. Conclusions The Government of Ghana and Non-Government Organisations should consider additional support to poor families so they can access high quality free infant male circumcision in rural Ghana.
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Affiliation(s)
- Thomas Gyan
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Level 4, Administration Building, Princess Margaret Hospital for Children, Perth, WA, 6008, Australia. .,Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
| | - Kimberley McAuley
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Level 4, Administration Building, Princess Margaret Hospital for Children, Perth, WA, 6008, Australia
| | - Natalie Strobel
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Level 4, Administration Building, Princess Margaret Hospital for Children, Perth, WA, 6008, 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
| | - Karen Edmond
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Level 4, Administration Building, Princess Margaret Hospital for Children, Perth, WA, 6008, Australia.,United Nations Children's Fund UNICEF, Kabul, Afghanistan
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Dorsal longitudinal foreskin cut is associated with reduced risk of HIV, syphilis and genital herpes in men: a cross-sectional study in Papua New Guinea. J Int AIDS Soc 2017; 20:21358. [PMID: 28406272 PMCID: PMC5515018 DOI: 10.7448/ias.20.01/21358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level. Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing. Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV. Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection. Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.
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Gorgiard C, Rey-Salmon C. [Forensic issues raised by circumcision: Review and case report]. Arch Pediatr 2016; 23:1153-1156. [PMID: 27692551 DOI: 10.1016/j.arcped.2016.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/16/2016] [Accepted: 08/09/2016] [Indexed: 11/18/2022]
Abstract
Circumcision is defined as the partial or total excision of the prepuce. It is one of the most frequently performed surgical procedures around the world. This practice primarily involves minors. The aim of this study was to review the legal aspects of ritual circumcision in France. We report the cases of an 11-year-old and a 15-year-old boy examined in the forensic unit at the Hôtel-Dieu hospital in Paris, after their father complained to the Minors Protection Brigade of Paris following the discovery of their circumcision. The examination conducted in the forensic unit found that the two boys had undergone recent circumcision. The total incapacity of work (ITT) was assessed as 5 days for the 15-year-old boy and 1 day for the 11-year-old boy. Ritual "medicalized" circumcision is legal in France, and does not fall under article 222-1 of the Criminal Code (torture and acts of barbarism) or article 16-1 of the Civil Code (inviolability of the human body). Circumcision is treated as a "serious act" by several areas of jurisprudence, which means it is imperative to obtain the consent of both parents. Moreover, it must be performed in a hospital by knowledgeable staff.
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Affiliation(s)
- C Gorgiard
- Urgences médicojudiciaires de l'Hôtel-Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France.
| | - C Rey-Salmon
- Urgences médicojudiciaires de l'Hôtel-Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
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Keetile M, Bowelo M. Factors associated with acceptability of child circumcision in Botswana -- a cross sectional survey. BMC Public Health 2016; 16:1053. [PMID: 27716224 PMCID: PMC5052788 DOI: 10.1186/s12889-016-3722-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background Safe male child circumcision has been recently adopted as a potential strategy to prevent HIV/AIDS transmission in later life in Botswana. Methods Data used was derived from a cross-sectional survey, the Botswana AIDS Impact Survey (BAIS) IV, conducted in 2013. A total sample of 7984 respondents in ages 15–64 years who had successfully completed the individual questionnaire during the survey were selected and included for analysis. Both descriptive and multivariable analyses were used to explore factors associated with acceptability of child circumcision. Data was analysed using SPSS version 22 program. Results Results indicate that about 84 % of participants said they would circumcise their male children aged 18 years and below, while 93 % were aware of the safe male circumcision program. Bivariate analyses results show that acceptability of child circumcision was significantly associated with sex, age, education, religion, residence, HIV status of the parent, fathers circumcision status, father's intention to circumcise and parent's knowledge about the safe male circumcision program. Multivariable analyses results indicate positive association between respondent's HIV positive status (OR, 3.5), Men's circumcision status (OR, 3.7), men's intention to circumcise (OR, 9.3) and acceptability of child circumcision. Conclusion Results of this study indicate some relatively high acceptability levels for child circumcision. Some individual behavioural factors influencing acceptability of child circumcision were also identified. This study provides a proper understanding of factors associated with acceptability of child circumcision which will ultimately enhance the successful roll-out of the school going children circumcision program in Botswana.
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Affiliation(s)
- Mpho Keetile
- Department of Population Studies, University of Botswana, Private Bag UB 00705, Gaborone, Botswana.
| | - Motsholathebe Bowelo
- Department of Population Studies, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
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Shaik MZ, Ebrahim S, Kredo T. Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions. Hippokratia 2016. [DOI: 10.1002/14651858.cd012250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Muhammed Zaki Shaik
- University of Kwazulu Natal; School of Clinical Medicine, Department of Surgery; 67 Bazley Avenue Sydenham Durban KwaZulu-Natal South Africa 4091
| | - Sumayyah Ebrahim
- University of KwaZulu-Natal; School of Clinical Medicine; 18 Magdelan Avenue, Reservoir Hills Durban KwaZulu-Natal South Africa 4091
| | - Tamara Kredo
- South African Medical Research Council; Cochrane South Africa; PO Box 19070 Tygerberg Cape Town Western Cape South Africa 7505
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Leas BF, Umscheid CA. Neonatal Herpes Simplex Virus Type 1 Infection and Jewish Ritual Circumcision With Oral Suction: A Systematic Review. J Pediatric Infect Dis Soc 2015; 4:126-31. [PMID: 26407411 PMCID: PMC4608492 DOI: 10.1093/jpids/piu075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/17/2014] [Indexed: 11/12/2022]
Abstract
Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection.
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Affiliation(s)
| | - Craig A. Umscheid
- Center for Evidence-Based Practice
- Department of Medicine
- Center for Clinical Epidemiology and Biostatistics
- Leonard Davis Institute of Health Economics
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia
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Introcaso CE, Xu F, Kilmarx PH, Zaidi A, Markowitz LE. Prevalence of circumcision among men and boys aged 14 to 59 years in the United States, National Health and Nutrition Examination Surveys 2005-2010. Sex Transm Dis 2015; 40:521-5. [PMID: 23965763 DOI: 10.1097/01.olq.0000430797.56499.0d] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2009, an estimated 3590 new heterosexually acquired HIV infections occurred in males in the United States. Three randomized controlled trials demonstrated that male circumcision decreased a man's risk for HIV acquisition through heterosexual sex. We describe circumcision prevalence in US males and determine circumcision prevalence among males potentially at increased risk for heterosexually acquired HIV infection. METHODS We estimated circumcision prevalence among men and boys aged 14 to 59 years using data from the National Health and Nutrition Examination Surveys 2005-2010. We defined men and boys with 2 or more female partners in the last year as potentially at increased risk for heterosexually acquired HIV infection. RESULTS Estimated circumcision prevalence was 80.5%. Prevalence varied significantly by year of birth, race/ethnicity, health insurance type, and family income. Circumcision prevalence among men and boys reporting 2 or more female partners in the last year was 80.4%, which corresponded to an estimated 3.5 million uncircumcised men and boys potentially at increased risk for heterosexually acquired HIV infection. Of these men and boys, 48.3% lacked health insurance. CONCLUSIONS Circumcision prevalence in the United States differs by demographic group, and half of uncircumcised men and boys potentially at increased risk for heterosexually acquired HIV are uninsured. These data could inform recommendations and cost analyses concerning circumcision in the United States.
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Affiliation(s)
- Camille E Introcaso
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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Gu C, Tian F, Jia Z, Li G, Meng Z, Xing W, Ding Y, Jin Z, Kan Q, Yang J. Introducing the Quill™ device for modified sleeve circumcision with subcutaneous suture: a retrospective study of 70 cases. Urol Int 2015; 94:255-61. [PMID: 25677813 DOI: 10.1159/000368660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/23/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the safety and feasibility of treatment for male circumcision using modified sleeve circumcision and subcuticular suture with the Quill™ device. METHODS From May 2011 to March 2012, 70 consecutive cases of male circumcision were performed using an alternative technique with the Quill™ device by a single surgeon in our institution. The inclusion and exclusion criteria for the selection process of this procedure were the same as for conventional circumcision. We evaluated the indications and perioperative outcomes. The circumcisions were performed as day-case procedures under local anesthesia. RESULTS All patients were followed up for a minimum of 3-6 months. The ages ranged from 8 to 68 (mean = 27.0 years, SD = 10). The indications for surgery were either cosmetic (n = 16, 22.9%) or medical [redundant prepuce (n = 36, 51.4%), phimosis (n = 5, 7.1%), paraphimosis (n = 2, 2.9%), balanoposthitis (n = 9, 12.9%), melanoma (n = 1, 1.4%), and condyloma acuminata (n = 1, 1.4%)] (n = 54, 77.1%). The mean operation time in this group was 29 min (19-38 min) when the Quill™ device was used. In all, 3 cases developed complications (4.3%). The final cosmetic result was satisfactory for both the patients and their spouses or parents. CONCLUSION This study showed that modified sleeve circumcision and subcuticular suture were safe and reliable surgical methods of circumcision that provide a better cosmetic result.
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Affiliation(s)
- Chaohui Gu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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[Actual controversies about circumcision]. Presse Med 2014; 43:1168-73. [PMID: 25218249 DOI: 10.1016/j.lpm.2014.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/24/2014] [Accepted: 04/09/2014] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Circumcision, the oldest and most frequently performed surgery in the world, is the subject of controversies. The aim of this study was to conduct a general review of circumcision in the light of the ten questions most frequently raised in the medical community. METHODS Automated search of scientific articles published has been used by interviewing computer databases Medline and Embase from 1990 to 2013. RESULTS The results of three randomized controlled trials have provided information on preventive contributory role of this medical male circumcision. This intervention reduces the risk of acquiring HIV infection, HSV2 infection and the carrier prevalence of HPV. Male circumcision has proven to be effective in reducing the risks of penile cancer and cervical cancer in female partners of circumcised men, urinary tract infections in infants and children. Complications are rare. CONCLUSION The health benefits of circumcision balance the procedure's risks. Circumcision could be considered as a kind of "surgical vaccine", especially in developing countries to prevent the transmission of HIV infection.
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Abstract
Abnormalities of the external genitalia span the spectrum from subtle findings of limited clinical significance to profound anomalies that call into question such essential questions as sex determination. In addition, missing a diagnosis of congenital adrenal hyperplasia in a newborn female child with virilized external genitalia can result in near-term mortality, whereas a large inguinal hernia could present rapidly with incarceration if undetected. To that end, this article seeks to present a survey of commonly encountered genital abnormalities while highlighting those scenarios that require multidisciplinary interventions.
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Kleine-Doepke L, Oesterhelweg L. Komplikationen religiös-ritueller Zirkumzisionen von Jungen im Neugeborenenalter. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Morris BJ, Bailis SA, Wiswell TE. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clin Proc 2014; 89:677-86. [PMID: 24702735 DOI: 10.1016/j.mayocp.2014.01.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/19/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023]
Abstract
The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
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Three phase III randomized controlled trials of topical resiquimod 0.01-percent gel to reduce anogenital herpes recurrences. Antimicrob Agents Chemother 2014; 58:5016-23. [PMID: 24709264 DOI: 10.1128/aac.00077-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resiquimod, a Toll-like receptor 7 and 8 agonist, stimulates production of cytokines that promote an antigen-specific T helper type 1 acquired immune response. Animal and phase II human trials showed posttreatment efficacy in reducing recurrent herpes lesion days and/or time to first recurrence. Three phase III randomized, double-blind, vehicle-controlled trials of topical resiquimod to reduce anogenital herpes recurrences were conducted in healthy adults with ≥4 recurrences within the prior year. Participants applied resiquimod 0.01% gel or vehicle gel 2 times per week for 3 weeks to each recurrence for 12 months. Trials 1 and 2 had 2:1 resiquimod-vehicle randomization. Trial 3 had 1:1:1 randomization for resiquimod and 500 mg valacyclovir orally twice daily for 5 days (RESI-VAL), resiquimod and oral placebo (RESI-PLA), and vehicle and oral placebo (VEH-PLA). The median time to first recurrence was similar for resiquimod and vehicle (trial 1, 60 and 56 days, P=0.7; trial 2, 54 and 48 days, P=0.47; trial 3, 51 [RESI-VAL], 55 [RESI-PLA], and 44 [VEH-PLA] days, P=not significant [NS]). The median time to healing of initial treated recurrence was longer for resiquimod (trial 1, 18 compared to 10 days, P<0.001; trial 2, 19 compared to 13 days, P=0.16; trial 3, 14 [RESI-VAL], 16 [RESI-PLA], and 8 [VEH-PLA] days, P<0.001). In trials 1 and 2, moderate to severe erythema and erosion/ulceration at the application site were more common in resiquimod recipients. In conclusion, no posttreatment efficacy of resiquimod 0.01% gel was observed. Increased application site reactions and initial recurrence healing time are consistent with resiquimod-induced cytokine effects.
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Xi RC, Sheng YR, Chen WH, Sheng L, Gang JJ, Tong Z, Shan Z, Shuo YF, Gang ZZ, Sheng YG, Ling XJ, Ying GH, Dong LC, Ju ZK. Male circumcision performed with 8-figure non-absorbable suture technique. Can Urol Assoc J 2014; 8:E142-7. [PMID: 24678353 DOI: 10.5489/cuaj.1521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We analyze the outcome of circumcisions performed with 8-figure non-absorbable suture (8FNS) and assess the feasibility of using the technique in male circumcision. METHODS We randomly divided 317 patients who would undergo circumcision between February 2009 and January 2012 into 2 groups. Each group was subdivided into children (age range: 7 to 15 years) and adult (range: 16 to 85 years). In the experiment group (n =166), we used 8FNS and in control group (n = 151), commonly absorbable suture (CAS) were used for the circumcised wound closure. The results of 2 groups were compared. We also performed a cost analysis and a mean 6-month follow-up (range: 1-12). Chi-square and Student's t-test were used in statistical analysis. Differences were considered significant (p < 0.05). RESULTS No patients were required to remove their sutures postoperatively. Among them, the sutures of the 8FNS for circumcision fell off spontaneously within 9 days (6.2 ± 1.57). There was no statistically significant difference between the 2 groups in surgical duration (16.2 ± 1.73 vs. 15.8 ± 2.01) and follow-up time (6.4 ± 3.82 vs. 6.2 ± 2.39). The overall complication rate of the 2 groups was 6.63% and 10.53% (p = 0.15), respectively. In addition, the complication rate among the adults was significantly lower in the 8FNS group compared to children (2.53% vs. 10.34%, p = 0.04). Also, the average cost (in US dollars) of 8FNS for circumcision was $20.7 ± $3.83 less than $35.8 ± $5.02 of CAS, which is a very significant difference (p < 0.0001). CONCLUSIONS 8FNS for circumcision is feasible, easy, safe and cost-effective, especially for adult males.
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Affiliation(s)
- Ren Chong Xi
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yin Rui Sheng
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Wang Hong Chen
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Li Sheng
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Ji Jing Gang
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhou Tong
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhang Shan
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yang Feng Shuo
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhang Zhi Gang
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Yu Guo Sheng
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Xu Jun Ling
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Guo Hong Ying
- Department of Urology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Liu Chun Dong
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Zhu Kun Ju
- Department of Educational Research, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
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Macipe-Costa RM, García-Sanchez N, Gimeno-Feliu LA, Navarra-Vicente B, Jiménez-Hereza JM, Moneo-Hernández I, Castillo-Laita JA, Lobera-Navaz P. Non-therapeutic male circumcision performed on immigrant children from Africa in Spain. Int J Public Health 2013; 59:351-8. [PMID: 24212325 DOI: 10.1007/s00038-013-0522-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 09/17/2013] [Accepted: 10/03/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To study the frequency, characteristics, and complications of non-therapeutic male circumcision on immigrant children from Africa in Spain. METHODS This descriptive study focused on primary care consultations conducted at 21 Aragon health centres during 2010 and 2011. The data were gathered through interviewer-administered questionnaires to the parents of African children. Sociodemographic variables were studied, along with others related to the practice of circumcision. RESULTS 283 questionnaires were obtained. 98.93 % of the children had undergone or were planning to undergo circumcision. 68.2 % were circumcised. Circumcisions were most frequently performed during a vacation to the country of origin (67.04 %), especially so for the Maghreb population. The remaining circumcisions had been performed in Spain. Half of the circumcisions practiced in Spain were performed at home, and 84 % of these were performed on Gambian children. CONCLUSIONS The current study demonstrates that, in Aragon, Spain, almost all immigrant children from Africa have been or will be circumcised and that a considerable proportion has been circumcised at home by unqualified individuals. Gambians are particularly at risk of performing unsafe circumcision.
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Affiliation(s)
- Rosa Maria Macipe-Costa
- Fuentes de Ebro Health Centre (Centro de Salud Fuentes de Ebro), Aragon Health Service (Servicio Aragonés de la Salud), Paseo de la Justicia, 69 Fuentes de Ebro, Saragossa, Spain,
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Walcott MM, Jolly PE, Ehiri JE, Funkhouser E, Kempf MC, Hickman D, Aung M, Zhang K. Factors associated with the acceptability of male circumcision among men in Jamaica. PLoS One 2013; 8:e75074. [PMID: 24066164 PMCID: PMC3774608 DOI: 10.1371/journal.pone.0075074] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/10/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the prevalence of male circumcision (MC) among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (<1 year) and older sons (1-17 years). METHODS A cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years was conducted in the western region of Jamaica. The survey included questions about the acceptance of MC for self, infants, and sons before and after an information session about the benefits of MC in preventing HIV/STI transmission. Logistic regression models were used to identify factors that were associated with acceptability of MC. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated from the models. RESULTS Fourteen percent of the men reported that they were circumcised. In the multivariable model, which adjusted for age, education, religion and income, there were increased odds of accepting MC for infants/sons among uncircumcised men who accepted MC for self (AOR=8.1; 95% CI = 4.1-15.9), believed they would experience more pleasure during sex if circumcised (AOR=4.0; 95% CI = 2.0-8.2), and reported having no concerns regarding MC (AOR=3.0; 95% CI = 1.8-4.8). Similarly, uncircumcised men who reported no concerns about MC or who believed that they would experience more pleasure during sex if circumcised were more likely to accept MC for self. CONCLUSION Providing men with information about MC increased acceptance of MC for self, infants (<17 years) and sons (1-17 years). Since targeted education on the benefits of male circumcision for prevention of HIV/STI can be effective in increasing acceptability of MC, health professionals should be trained, and willing to discuss MC with men in healthcare facilities and in the community.
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Affiliation(s)
- Melonie M. Walcott
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Pauline E. Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - John E. Ehiri
- Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mirjam C. Kempf
- Department of Family/Child Health and Caregiving and Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Deborah Hickman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Maung Aung
- Epidemiology Unit, Western Regional Health Authority, Jamaica
| | - Kui Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Bates MJ, Ziegler JB, Kennedy SE, Mindel A, Wodak AD, Zoloth LS, Tobian AAR, Morris BJ. Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights. BMC Pediatr 2013; 13:136. [PMID: 24010685 PMCID: PMC3846407 DOI: 10.1186/1471-2431-13-136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 09/06/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent attempts in the USA and Europe to ban the circumcision of male children have been unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that non-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the parents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create a precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental responsibilities and freedoms, and public health. DISCUSSION The TLRI report ignores the scientific consensus within medical literature about circumcision. It contains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United Nations Convention on the Rights of the Child are consistent with parents being permitted to authorize circumcision for their male child. Uncritical acceptance of the TLRI report's recommendations would strengthen and legitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The medical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based medical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice. There is no explanation of how the State could impose criminal charges against doctors and parents, nor of how such a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined. The proposal could easily be used inappropriately, and discriminates against parents not tied to the religions specified. With time, religious exemptions could subsequently be overturned. The law, governments and the medical profession should reject the TLRI recommendations, especially since the recent affirmative infant male circumcision policy statement by the American Academy of Pediatrics attests to the significant individual and public health benefits and low risk of infant male circumcision. SUMMARY Doctors should be allowed to perform medical procedures based on sound evidence of effectiveness and safety with guaranteed protection. Parents should be free to act in the best interests of the health of their infant son by having him circumcised should they choose.
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Affiliation(s)
| | - John B Ziegler
- Department of Immunology & Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
- School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sean E Kennedy
- School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Alex D Wodak
- St Vincent’s Hospital and Kirby Institute, University of New South Wales, Sydney, NSW 2010, Australia
| | - Laurie S Zoloth
- Program in Bioethics and Medical Humanities, Northwestern University School of Medicine, Chicago, IL 60611-3015, USA
| | - Aaron AR Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
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Kokorowski PJ, Routh JC, Hubert K, Graham DA, Nelson CP. Trends in revision circumcision at pediatric hospitals. Clin Pediatr (Phila) 2013; 52:699-706. [PMID: 23820002 PMCID: PMC4130460 DOI: 10.1177/0009922813492878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We sought to determine the incidence of revision circumcision at freestanding children's hospitals, and examine trends over time. METHODS We searched the Pediatric Health Information Systems database to identify boys undergoing revision circumcision (RC), primary non-newborn circumcision (PC), or lysis of penile adhesions (LPA) from 2004 to 2009. Rates of RC procedures were calculated by dividing the incidence of procedures by the total male ambulatory surgical volume. RESULTS We identified 34,568 patients of whom 5632 underwent RC, 25,768 PC, and 3168 LPA. The rate of RC increased 119%, which was significantly more than PC (19%; P<.001) or LPA (37%; P<.001). Urologists performed 76% of RC and 12% were performed with other genitourinary procedures. Boys undergoing RC were predominately white (60%) and publicly insured (61%). CONCLUSIONS There was a disproportionate increased rate of RC performed at Pediatric Health Information Systems hospitals compared with PC or LPA. Wide variation exists in rate increases among hospitals.
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Affiliation(s)
- Paul J. Kokorowski
- Division of Urology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | | | - Katherine Hubert
- Department of Urology, Boston Children’s Hospital, Harvard Medical School, Boston, MA,Harvard Pediatric Health Services Research Fellowship Program, Harvard Medical School, Boston, MA
| | - Dionne A. Graham
- Clinical Research Program, Children’s Hospital Boston, Harvard Medical School, Boston, MA
| | - Caleb P. Nelson
- Department of Urology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
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Kitara DL, Ocero A, Lanyero J, Ocom F. Roll-out of medical male circumcision (MMC) for HIV prevention in non-circumcising communities of Northern Uganda. Pan Afr Med J 2013; 15:100. [PMID: 24198894 PMCID: PMC3810160 DOI: 10.11604/pamj.2013.15.100.2338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 07/06/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Recent studies have shown that circumcision reduces HIV/AIDS infection rates by 60% among heterosexual African men. Public health officials are arguing that circumcision of men should be a key weapon in the fight of HIV/AIDS in Africa. Experts estimate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure becomes widely used. Some communities in Uganda have misconceptions to MMC and resist the practice. Methods To roll out MMC to a non-circumcising population of Northern Uganda from June 2011 as a strategy to increase access and prevent the spread of HIV/AIDS. Results Circumcision in a non-circumcising communities of Lango and Acholi sub-regions with a population of about 0.5 million mature males 15-49 years. Enrolment was voluntary, clinical officers, nurses carried out MMC after training in the surgical procedure. Mass sensitization and mobilization was conducted through radios, community leaderships and spouses. Cervical cancer screening was incorporated at circumcision sites and used as incentive for the women. Circumcisions were conducted at static sites, camps and outreach services where VCT and adverse events (AEs) were recorded and managed. All clients assented/or consented. Conclusion A total of 26, 150 males were circumcised in eight months. The AEs rate was 1.2% and was mild. 2,650 women were screened for cervical cancer and positive test rate was 1.7%. Mobilization and sensitization were by radios and spouses’ involvement in cervical cancer screening exercise.
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Affiliation(s)
- David Lagoro Kitara
- Faculty of Medicine, Department of Surgery, Gulu University, P.O Box 166, Gulu, Uganda
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Haliloglu AH, Gokce MI, Tangal S, Boga MS, Tapar H, Aladag E. Comparison of Postoperative Analgesic Efficacy of Penile Block, Caudal Block and Intravenous Paracetamol for Circumcision: A prospective Randomized Study. Int Braz J Urol 2013; 39:551-7. [DOI: 10.1590/s1677-5538.ibju.2013.04.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/12/2013] [Indexed: 11/22/2022] Open
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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
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Male Circumcision. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database Syst Rev 2012; 11:CD009129. [PMID: 23152269 DOI: 10.1002/14651858.cd009129.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neonatal circumcision is a fairly common surgical procedure that may be carried out for medical reasons, one of them being prevention of urinary tract infections (UTI) in male infants. Circumcision could help in reducing the incidence of UTI by reducing periurethral bacterial colonization, which is accepted as a potential risk factor in UTI. Evidence is needed to inform the benefits or harm for the routine use of this intervention. OBJECTIVES To assess the effectiveness and safety of routine neonatal circumcision for the prevention of UTIs in infancy. SEARCH METHODS We searched the Cochrane Neonatal Review Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We completed this search 30 June 2011. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Two review authors had planned to independently screen studies, extract data and assess risk of bias using standard Cochrane Collaboration methodologies. We did not identify any studies for inclusion in this review. MAIN RESULTS We did not identify any relevant studies after a comprehensive search of the literature. AUTHORS' CONCLUSIONS We were unable to identify any randomised controlled trials on the use of routine neonatal circumcision for prevention of UTI in male infants. Until further evidence becomes available, clinicians should continue to base their decisions on position statements and recommendations and in conjunction with the opinions of the children's parents.
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Abdulla A, Daya D, Pinthus J, Davies T. Buried penis: An unrecognized risk factor in the development of invasive penile cancer. Can Urol Assoc J 2012; 6:E199-202. [PMID: 23093645 DOI: 10.5489/cuaj.11226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One of the documented benefits of neonatal circumcision is protection against invasive penile cancer. To date there have been a handful of published cases of invasive penile cancer in men circumcised as neonates. We report a case of a 73-year-old man, with a history of neonatal circumcision with no evidence of previous human papillomavirus exposure, who developed a buried penis secondary to obesity. He was diagnosed with Grade 2, pT3N0 squamous cell carcinoma of the penis. This report suggests that buried penis may pose a risk factor for the development of penile cancer despite the protective effects of neonatal circumcision. Thus periodic examination of a buried penis is warranted even in patients with no risk factors for penile cancer. A review of the literature is provided.
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Affiliation(s)
- Alym Abdulla
- McMaster Institute of Urology, Division of Urology, Department of Surgery McMaster University, Hamilton, ON
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Young MR, Bailey RC, Odoyo-June E, Irwin TE, Obiero W, Ongong'a DO, Badia JA, Agot K, Nordstrom SK. Safety of over twelve hundred infant male circumcisions using the Mogen clamp in Kenya. PLoS One 2012; 7:e47395. [PMID: 23082162 PMCID: PMC3474828 DOI: 10.1371/journal.pone.0047395] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022] Open
Abstract
Background Several sub-Saharan African countries plan to scale-up infant male circumcision (IMC) for cost-efficient HIV prevention. Little data exist about the safety of IMC in East and southern Africa. We calculated adverse event (AE) rate and risks for AEs associated with introduction of IMC services at five government health facilities in western Kenya. Methods AE data were analyzed for IMC procedures performed between September, 2009 and November, 2011. Healthy infants aged ≤2 months and weighing ≥2.5 kg were eligible for IMC. Following parental consent, trained clinicians provided IMC services free of charge under local anesthesia using the Mogen clamp. Odds ratios and 95% confidence intervals were used to explore AE risk factors. Findings A total of 1,239 IMC procedures were performed. Median age of infants was 4 days (IQR = 1, 16). The overall AE rate among infants reviewed post-operatively was 2.7% (18/678; 95%CI: 1.4, 3.9). There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were mild or moderate and were treated conservatively. Babies one month of age or older were more likely to have an AE (OR 3.20; 95%CI: 1.23, 8.36). AE rate did not differ by nurse versus clinical officer or number of previous procedures performed. Conclusion IMC services provided in Kenyan Government hospitals in the context of routine IMC programming have AE rates comparable to those in developed countries. The optimal time for IMC is within the first month of life.
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Affiliation(s)
- Marisa R Young
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA.
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Kacker S, Frick KD, Gaydos CA, Tobian AAR. Costs and effectiveness of neonatal male circumcision. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2012; 166:910-8. [PMID: 22911349 PMCID: PMC3640353 DOI: 10.1001/archpediatrics.2012.1440] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the expected change in the prevalence of male circumcision (MC)-reduced infections and resulting health care costs associated with continued decreases in MC rates. During the past 20 years, MC rates have declined from 79% to 55%, alongside reduced insurance coverage. DESIGN We used Markov-based Monte Carlo simulations to track men and women throughout their lifetimes as they experienced MC procedure-related events and MC-reduced infections and accumulated associated costs. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty. SETTING United States. PARTICIPANTS Birth cohort of men and women. INTERVENTION Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited). OUTCOMES MEASURED Lifetime direct medical cost (2011 US$) and prevalence of MC-reduced infections. RESULTS Reducing the MC rate to 10% will increase lifetime health care costs by $407 per male and $43 per female. Net expenditure per annual birth cohort (including procedure and complication costs) is expected to increase by $505 million, reflecting an increase of $313 per forgone MC. Over 10 annual cohorts, net present value of additional costs would exceed $4.4 billion. Lifetime prevalence of human immunodeficiency virus infection among males is expected to increase by 12.2% (4843 cases), high- and low-risk human papillomavirus by 29.1% (57 124 cases), herpes simplex virus type 2 by 19.8% (124 767 cases), and infant urinary tract infections by 211.8% (26 876 cases). Among females, lifetime prevalence of bacterial vaginosis is expected to increase by 51.2% (538 865 cases), trichomoniasis by 51.2% (64 585 cases), high-risk human papillomavirus by 18.3% (33 148 cases), and low-risk human papillomavirus by 12.9% (25 837 cases). Increased prevalence of human immunodeficiency virus infection among males represents 78.9% of increased expenses. CONCLUSION Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women.
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Affiliation(s)
- Seema Kacker
- Department of Pathology, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA
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Bisono GM, Simmons L, Volk RJ, Meyer D, Quinn TC, Rosenthal SL. Attitudes and decision making about neonatal male circumcision in a Hispanic population in New York City. Clin Pediatr (Phila) 2012; 51:956-63. [PMID: 22511191 PMCID: PMC3777274 DOI: 10.1177/0009922812441662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To understand attitudes and decision making regarding neonatal male circumcision. METHODS Parents (n = 150) with a son 3 years old were interviewed regarding demographics, communication with a medical provider, attitudes, and process by which the neonatal circumcision decision was made. RESULTS Thirty-three percent of sons were circumcised. In univariate analyses, choosing male circumcision was associated with parents being interviewed in English, the father being circumcised, positive attitudes, being informed of the advantages of circumcision, making a decision before birth, and being offered a choice. In the final model, parents who came from a culture and family that believed in circumcision and who believed that it was not too risky were more likely to circumcise their sons. CONCLUSIONS Decisions regarding circumcision appear to be influenced by values, risk perceptions, and medical providers. Future research should address ways of ensuring that families have the opportunity to make an informed decision.
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Affiliation(s)
- Gabriela M. Bisono
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Lisa Simmons
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Robert J. Volk
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dodi Meyer
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan L. Rosenthal
- Department of Pediatrics and Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at NewYork Presbyterian
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Voluntary medical male circumcision: an HIV prevention priority for PEPFAR. J Acquir Immune Defic Syndr 2012; 60 Suppl 3:S88-95. [PMID: 22797745 DOI: 10.1097/qai.0b013e31825cac4e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all.
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Morris BJ, Wamai RG. Biological basis for the protective effect conferred by male circumcision against HIV infection. Int J STD AIDS 2012; 23:153-9. [PMID: 22581866 DOI: 10.1258/ijsa.2011.011228] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Here we provide an up-to-date review of research that explains why uncircumcised men are at higher risk of HIV infection. The inner foreskin is a mucosal epithelium deficient in protective keratin, yet rich in HIV target cells. Soon after sexual exposure to infected mucosal secretions of a HIV-positive partner, infected T-cells from the latter form viral synapses with keratinocytes and transfer HIV to Langerhans cells via dendrites that extend to just under the surface of the inner foreskin. The Langerhans cells with internalized HIV migrate to the basal epidermis and then pass HIV on to T-cells, thus leading to the systemic infection that ensues. Infection is exacerbated in inflammatory states associated with balanoposthitis, the presence of smegma and ulceration - including that caused by infection with herpes simplex virus type 2 and some other sexually transmitted infections (STIs). A high foreskin surface area and tearing of the foreskin or associated frenulum during sexual intercourse also facilitate HIV entry. Thus, by various means, the foreskin is the primary biological weak point that permits HIV infection during heterosexual intercourse. The biological findings could explain why male circumcision protects against HIV infection.
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Affiliation(s)
- B J Morris
- Basic & Clinical Genomics Laboratory, School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia.
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Affiliation(s)
- Colleen K Cagno
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ 85711-1827, USA.
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