Complications Of Male Circumcision: A Review Of 39 Cases

摘要

Introduction: male circumcision is one of the most commonly performed procedures in neonates, infants and children because of religious, cultural and medical reasons. Approximately one in three men is circumcised globally. To minimize the possibility of a poor outcome, it is important to know about complications and their management. We report the finding of 39 referral cases referred of circumcision complications required secondary interventions.Materials and Methods: the documents of 39 patients with circumcision complications have been referred to our department in the period of 2 years (2007-2009) were reviewed retrospectively.Results: the patients ages were 1 week to 10 year (mean age 24 month). Most common complication was hemorrhage seen in 13 cases (33%) followed by meatal stenosis in 7(18%) and the serious complications were glanopreputial skin fusion and penile amputation each one in 1 case (2.5%).28 cases (71.7%) had been circumcised by General Practitioners.Conclusion: Circumcision is easy but may be associated with many serious complications and still needs to full training or re-training for both traditional and medically trained providers. Introduction Male circumcision is one of the most common operations that performed in neonates, infants and children because of religious, cultural and medical reasons. About 60% of male newborns in United States in 1992 were circumcised (1). In Muslim countries, all boys have to be circumcised. The possible benefits of circumcision are the reduction of penile cancer risk, urinary tract infections, sexually transmitted diseases and phimosis (2).Complications of circumcision are bleeding, infection , insufficient foreskin removal, excessive foreskin removal, adhesion or skin bridges, inclusion cysts or abnormal healing, meatitis, meatal stenosis, urinary retention, phimosis, chordea, hypospadias, epispadias, urethrocutaneous fistula, necrosis of the penis, amputation of the glans and death.The complication rates of circumcision procedures is from 0% to 16% (median frequency 1.5%) (3). It is a relatively simple, quick and safe procedure when performed in a clinical setting under aseptic conditions by a trained practitioner with proper instrumentation. However such conditions do not always prevail. There are few reliable data on complication rates from male circumcision in clinical settings in developing countries. In this report we describe the finding of 39 cases referred for complications after circumcision that required secondary surgical intervention. Materials and Methods The documents of 39 patients with circumcision complications were referred to our department in the period of 2 years (2007-2009) and were evaluated retrospectively. All information about age, method of circumcision, circumcision provider and kind of complication gathered and the frequency of complications were assessed. We excluded patients with inherited bleeding disorders of this study. The study was approved by the Ethics Committee of our University of Medical Sciences for using the patients’ information.Complications were divided in two groups, minor and major or severe and life threatening. Bleeding without changing hemoglobin, meatal stenosis, incomplete circumcision, hematoma, phimosis and skin bridges were defined as minor complications. Major and severe complications with life threatening sequels included Severe hemorrhage (Hb<7 gr/dl), Urinary retention, penile shaft Urinoma and Circumcision in hypospadias. Penile amputation, Glans and skin fusion, Phimosis, obstructive uropathy (Cr>7 mg/dl), Urethral fistula need for re-surgery or plastic surgery. This study did not included medically managed complications such as infection, or meatitis. Results The mean age of patients was 1 week to 10 year (mean age 24 month) (chart 1). Complications were divided in two groups: minor and severe or life threatening (table 1)