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Circumcision: Avoidance and Treatment of Complications

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Textbook of Male Genitourethral Reconstruction

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Abstract

Circumcision has been practiced in large numbers for millennia. One might have thought that, given how long we have been performing this operation and the number of times it has been done, we might have perfected the technique by now. Not a bit of it. Any genitourinary tertiary referral centre will be all too familiar with patients referred in because the circumcision has not been successful or worse. This may be due to poor hygiene or technique, but, from time to time, it can be a technically difficult operation, either due to the severity of the pathology or occult anatomical variations. In this chapter, the authors discuss the indications for circumcision and, equally important, circumstances when circumcision should be avoided or modified. This chapter also describes a way to perform a routine circumcision, deal with the difficult circumcision, and gives an outline of the principles used to deal with complications of the operation or the disease the necessitated it in the first place.

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References

  1. Ware EW. A brief history of urology at Baylor University medical center. Proc (Bayl Univ Med Cent). 2003;16(4):430–4.

    Google Scholar 

  2. Weiss H, Polonsky P, Bailey R, et al. Circumcision global trends and determinants of prevalence, safety and acceptability. World health organisation and joint united nations programme on HIV/AIDSE. 2007. http://data.unaids.org/pub/report/2007/jc1360_male_circumcision_en.pdf.

  3. Talini C, Antunes LA, de Carvalho BCN, et al. Circumcision: postoperative complications that required re-operation. Einstein. 2018;16(3):eAO4241. https://doi.org/10.1590/S1679-45082018AO4241.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bhat A. Preservation of urethra devoid of corpus spongiosum in patients undergoing urethroplasty. Iendian Journal of Urology: IJU: Journal of the Urological Society of India. 2007;23(2):213–4.

    Google Scholar 

  5. Vincent M, Byles SD, Duncan N. Penoplasty – not circumcision – for buried penis. West Indian Med J. 2014;63(5):541–4. https://doi.org/10.7727/wimj.2013.127.

    Article  CAS  PubMed  Google Scholar 

  6. Rashid AM, Williams RM, Parry D, Malone PR. Actinomycosis associated with pilonidal sinus of the penis. J Urol. 1992;148(2 Pt 1):405–6.

    CAS  PubMed  Google Scholar 

  7. Storm DW, Baxter C, Koff SA, Alpert S. The relationship between obesity and complications after neonatal circumcision. J Urol. 2011;186(4 Suppl):1638–41.

    PubMed  Google Scholar 

  8. Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86(4):459–65.

    CAS  PubMed  Google Scholar 

  9. Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014;25:615–26.

    PubMed  Google Scholar 

  10. Oster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968;43(228):200–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Ziada M, Parnham A, Christodoulidou M, Freeman A, Bunker C, Muneer A. Does residual penile intraepithelial neoplasia (PeIN) require adjuvant chemotherapy after surgical excision. Eur Urol Suppl. 2017;16(3):e1243.

    Google Scholar 

  12. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005;90:853–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Garaffa G, Christopher N, Ralph DJ. The management of genital lymphoedema. BJU Int. 2008;102(4):480–4.

    PubMed  Google Scholar 

  14. Gairdner D. The fate of the foreskin. A study of circumcision. Br Med J. 1949;2(4642):1433–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Bunker CB, Shim TN. Male Genital Lichen Sclerosus. Indian J Dermatol. 2015;60(2):111–7.

    PubMed  PubMed Central  Google Scholar 

  16. Summerton DJ, McNally DAJ, Malone PS. Congenital megaprepuce: an emerging condition – how to recognise and treat it. BJU Int. 2000;86(4):519–22.

    CAS  PubMed  Google Scholar 

  17. Soumaré M, Seydi M, Dia NM, Diop SA, N’dour CT, Diouf L, Diop BM, Sow PS. [Post-circumcision tetanus in Dakar, Senegal]. Bull Soc Pathol Exot. 2008;101(1):54–7.

    Google Scholar 

  18. Meel BL. Traditional male circumcision-related fatalities in the Mthatha area of South Africa. Med Sci Law. 2010;50(4):189–91.

    CAS  PubMed  Google Scholar 

  19. Appiah KA, Gyasi-Sarpong CK, Azorliade R, et al. Circumcision-related tragedies seen in children at the Komfo Anokye teaching hospital, Kumasi, Ghana. BMC Urol. 2016;16(1):65.

    PubMed  PubMed Central  Google Scholar 

  20. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol. 2010. Feb16;10(2)

    Google Scholar 

  21. Thorup J, Thorup SC, Ifaoui IB. Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013;60(8):A4681.

    PubMed  Google Scholar 

  22. Edler G, Axelsson I, Barker GM, Lie S, Naumburg E. Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure. Acta Paediatr. 2016;105(7):842–50.

    PubMed  Google Scholar 

  23. Galukande M, Sekavuga DB, Muganzi A, Coutinho A. Fournier’s gangrene after adult male circumcision. Int J Emerg Med. 2014;7:37.

    PubMed  PubMed Central  Google Scholar 

  24. Chan KH, Whittam BM, Moser EAS, Cain MP, Bennett WE Jr. Adverse events associated with surgical antibiotic prophylaxis for outpatient circumcisions at US children’s hospitals. J Pediatr Urol 2017;13(2):205.e1–205205.e6.

    Google Scholar 

  25. Shim TN, Andrich DE, Mundy AR, et al. Lichen sclerosus associated with perineal urethrostomy. Br J Dermatol. 2014;170(1):222–3.

    CAS  PubMed  Google Scholar 

  26. Nyatsanza F, Holden B. Should male circumcision be considered curative treatment for lichen sclerosus. Sex Transm Infect. 2015;91:A81.

    Google Scholar 

  27. Alei G, Letizia P, Alei L, et al. Reconstructive surgery of the sulcus of the glans penis for balanopreputial adhesion due to lichen sclerosus. Our experience and medicolegal implications. Ann Ital Chir. 2014;85(2):195–200.

    PubMed  Google Scholar 

  28. Skrodzka M, Ayers J, Rea A, et al. How to do a circumcision when the foreskin is welded to the glans. The ROLOCS (restoration of the lost obscured coronal sulcus) procedure. J Sex Med. 2018;15(7):S179–80.

    Google Scholar 

  29. Barbagli G, Mirri F, Gallucci M, Sansalone S, Romano G, Lazzeri M. Histological evidence of urethral involvement in male patients with genital lichen sclerosus: a preliminary report. J Urol. 2011;185(6):2171–6.

    PubMed  Google Scholar 

  30. Eason JD, McDonnell M, Clark G. Male ritual circumcision resulting in acute renal failure. BMJ. 1994;309(6955):660–1.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Upadhyay V, Hammodat HM, Pease PW. Post circumcision meatal stenosis: 12 years’ experience. N Z Med J. 1998;111(1060):57–8.

    CAS  PubMed  Google Scholar 

  32. Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients. Eur Urol. 2009;55(4):945–54.

    PubMed  Google Scholar 

  33. Searles JM, MacKinnon AE. Home-dilatation of the urethral meatus in boys. BJU Int. 2004;93(4):596–7.

    CAS  PubMed  Google Scholar 

  34. Malone P. A new technique for meatal stenosis in patients with lichen sclerosus. J Urol. 2004;172(3):949–52.

    PubMed  Google Scholar 

  35. Steffens JA, Anheuser P, Treiyer AE, Reisch B, Malone PR. Plastic meatotomy for pure meatal stenosis in patients with lichen sclerosus. BJU Int. 2010;105(4):568–72.

    PubMed  Google Scholar 

  36. Navalón P, et al. Long-term follow-up of Malone meatoplasty for meatal stenosis in patients with lichen Sclerosus. J Anesth Surg. 2016;4(2):121–4.

    Google Scholar 

  37. Treiyer A, Anheuser P, Reisch B, Steffens J. Treatment of urethral meatus stenosis due to balanitis xerotic obliterans. Long term results using the meatoplasty of Malone. Actas Urol Esp. 2011;35(8):494–8.

    CAS  PubMed  Google Scholar 

  38. Garaffa G, Raheem AA, Ralph DJ. An update on penile reconstruction. Asian J Androl. 2011;13(3):391–4. https://doi.org/10.1038/aja.2011.29.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Venn SN, Mundy AR. Urethroplasty for balanitis xerotica obliterans. Br J Urol. 1998;81(5):735–7.

    CAS  PubMed  Google Scholar 

  40. Edney MT, Lopes JF, Schned A, Ellsworth PI, Cendron M. Time course and histology of urethrocutaneous fistula formation in a porcine model of urethral healing. Eur Urol. 2004;45(6):806–10.

    PubMed  Google Scholar 

  41. Shiraki IW. Congenital megalourethra with urethrocutaneous fistula following circumcision: a case report. J Urol. 1973;109(4):723–6.

    CAS  PubMed  Google Scholar 

  42. Elbakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years’ experience. BJU Int. 2001;88(6):590–5.

    CAS  PubMed  Google Scholar 

  43. Karakus SC, User IR, Akcaer V, Ozokutan BH, Ceylan H. A simple technique for small-diameter urethrocutaneous fistula repair: ligation. J Pediatr Urol. 2017;13(1):88–90.

    CAS  PubMed  Google Scholar 

  44. Malone PR. Urethrocutaneous fistula: preserve the tract and turn it inside out: the PATIO repair. BJU Int. 2009;104(4):550–4.

    PubMed  Google Scholar 

  45. Rathod K, Loyal J, More B, Rajimwale A. Modified PATIO repair for urethrocutaneous fistula post-hypospadias repair: operative technique and outcomes. Pediatr Surg Int. 2017;33(1):109–12.

    PubMed  Google Scholar 

  46. Nerli RB, Metgud T, Bindu S, Guntaka A, Patil S, Neelgund SE, Hiremath MB. Solitary urethrocutaneous fistula managed by the PATIO repair. J Pediatr Urol. 2011;7(2):166–9.

    CAS  PubMed  Google Scholar 

  47. Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T’Sjoen G, Vlietinck R, Hoebeke PB. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int. 2013;111(5):820–7.

    PubMed  Google Scholar 

  48. Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction? – a systematic review. J Sex Med. 2013;10(11):2644–57.

    PubMed  Google Scholar 

  49. Seleim HM, Elbarbary MM. Major penile injuries as a result of cautery during newborn circumcision. J Pediatr Surg. 2016;51(9):1532–7.

    PubMed  Google Scholar 

  50. Ramsay JWA, Shepherd A, Butler M, et al. A comparison of bipolar and monopolar diathermy probes in experimental animals. Urol Res. 1985;13(2):99–102.

    CAS  PubMed  Google Scholar 

  51. Altokhais TI. Electrosurgery use in circumcision in children: is it safe? Urol Ann. 2017;9:1–3.

    PubMed  PubMed Central  Google Scholar 

  52. Guizhong L, Feng H, Guangling H, Libo M, Kun L, Yuming S. Management of penile defects: a review. J Reconstr Microsurg. 2012;28(5):293–6.

    PubMed  Google Scholar 

  53. Biswas G. Technical considerations and outcomes in penile replantation. Semin Plast Surg. 2013;27(4):205–10. https://doi.org/10.1055/s-0033-1360588.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA. Newborn penile glans amputation during circumcision and successful reattachment. J Urol. 1995;153(3 Pt1):778–9.

    CAS  PubMed  Google Scholar 

  55. Bracka A. Organerhaltende operationstechnik bei karzinomen der glans penis. Aktuelle Urol. 1996;27:1–V1.

    Google Scholar 

  56. Kranz J, Parnham A, Albersen M, Sahdev V, Ziada M, Nigam R, Muneer A, Steffens J, Malone P. Urethral centralization and pseudo-glans formation after partial penectomy. Urologe A. 2017;56(10):1293–7.

    CAS  PubMed  Google Scholar 

  57. Garaffa G, Gentile V, Antonini G, Tsafrakidis P, Raheem AA, Ralph DJ. Penile reconstruction in the male. Arab J Urol. 2013;11(3):267–71.

    PubMed  PubMed Central  Google Scholar 

  58. Ziylan O, Acar Ö, Özden BC, Tefik T, Dönmez Mİ, Oktar T. A practical approach for the correction of iatrogenic penile skin loss in children: scrotal embedding technique. Turk J Urol. 2015;41(4):235–8.

    PubMed  PubMed Central  Google Scholar 

  59. Mokhless IA, Abdeldaeim HM, Rahman A, Zahran M, Safwat A. Penile advancement and lengthening for the management of post-circumcision traumatic short penis in adolescents. Urology. 2010;76(6):1483–7.

    PubMed  Google Scholar 

  60. Li CY, Kayes O, Kell PD, Christopher N, Minhas S, Ralph DJ. Penile suspensory ligament division for penile augmentation: indications and results. Eur Urol. 2006;49(4):729–33.

    PubMed  Google Scholar 

  61. Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int. 2007;100(4):899–905.

    PubMed  Google Scholar 

  62. Garaffa G, Antonini G, Gentile V, Ralph DJ. Phalloplasty for the genetic male. Transl Androl Urol. 2012;1(2):103–8.

    PubMed  PubMed Central  Google Scholar 

  63. Raveenthiran V. Controversies of sex re-assignment in genetic males with congenital inadequacy of the penis. Indian J Pediatr. 2017;84(9):700–8.

    PubMed  Google Scholar 

  64. Ochoa B. Trauma of the external genitalia in children: amputation of the penis and emasculation. J Urol. 1998;160(3 Pt 2):1116–9.

    CAS  PubMed  Google Scholar 

  65. Szafran AA, Redett R, Burnett AL. Penile transplantation: the US experience and institutional program set-up. Transl Androl Urol. 2018;7(4):639–45.

    PubMed  PubMed Central  Google Scholar 

  66. van der Merwe A, Graewe F, Zühlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, Ackermann H, Spies PV, Opondo D, Al-Qaoud T, Bezuidenhout K, Nel JD, Bailey B, Moosa MR. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet. 2017;390(10099):1038–47.

    PubMed  Google Scholar 

  67. Patel HD. Human penile transplantation: an unjustified ethical dilemma? Eur Urol. 2018;74(3):246–7.

    PubMed  Google Scholar 

  68. Najari B, Flannigan R, Hobgood J, Paduch D. Attitudes toward penile transplantation among urologists and health professionals. Sex Med. 2018 26. pii: S2050-1161(18)30057–6.

    Google Scholar 

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Authors and Affiliations

  1. University College London Hospital, Institute of Urology, Department of Andrology, London, UK

    Marta Skrodzka & Peter Malone

  2. The Royal Berkshire Hospital, Harold Hopkins Department of Urology, Reading, UK

    Peter Malone

Authors
  1. Marta Skrodzka
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  2. Peter Malone
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Correspondence to Peter Malone .

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Editors and Affiliations

  1. School of Medicine, University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. Kulkarni Reconstructive Urology Center, Pune, India

    Sanjay B. Kulkarni

  3. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Tobias S. Köhler

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Skrodzka, M., Malone, P. (2020). Circumcision: Avoidance and Treatment of Complications. In: Martins, F.E., Kulkarni, S.B., Köhler, T.S. (eds) Textbook of Male Genitourethral Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-21447-0_51

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  • DOI: https://doi.org/10.1007/978-3-030-21447-0_51

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