Download PDF
CC BY 4.0 · Surg J (N Y) 2020; 06(04): e188-e191
DOI: 10.1055/s-0040-1721430
Original Article

Pediatric Circumcision in the 21st Century National Health Service: A Snapshot of Practice in a United Kingdom Center

Patrick Jones 
1   Department of Urology, Great Western Hospital, Swindon, United Kingdom
,
Helen Rooney 
1   Department of Urology, Great Western Hospital, Swindon, United Kingdom
,
Amr Hawary
1   Department of Urology, Great Western Hospital, Swindon, United Kingdom
› Author Affiliations Funding None
› Further Information
   Permissions and Reprints

Abstract

Introduction Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported.

Aim The aim of this study was to report outcomes of therapeutic circumcision from our center.

Methods Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services.

Results Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3–16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% (n = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% (n = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% (n = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%.

Conclusion Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.

Keywords

circumcision - balanitis xerotica obliterans - phimosis - pediatrics - surgery


Publication History

Received: 29 April 2020

Accepted: 14 September 2020

Article published online:
14 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y. Complications of circumcision in Israel: a one year multicenter survey. Isr Med Assoc J 2005; 7 (06) 368-370
    PubMedGoogle Scholar
  • 2 Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 2006; 6: 21
    CrossrefPubMedGoogle Scholar
  • 3 El Bcheraoui C, Zhang X, Cooper CS, Rose CE, Kilmarx PH, Chen RT. Rates of adverse events associated with male circumcision in U.S. medical settings, 2001 to 2010. JAMA Pediatr 2014; 168 (07) 625-634
    CrossrefPubMedGoogle Scholar
  • 4 Morris BJ, Krieger J. Non-therapeutic male circumcision. Paediatr Child Health 2020; 30: 102-107
    CrossrefPubMedGoogle Scholar
  • 5 Beecham L. GMC issues guidelines on circumcision. BMJ 1997; 314 (7094): 1573
    CrossrefPubMedGoogle Scholar
  • 6 Singh L, Sengar M, Goyal S, Mansi M, Khurana N, Mohta A. Childhood phimosis secondary to lichen sclerosus: is there a spatial pattern of histopathological changes?. Am J Dermatopathol 2018; 40 (11) 824-828
    CrossrefPubMedGoogle Scholar
  • 7 Ceylan K, Burhan K, Yilmaz Y, Can S, Kuş A, Mustafa G. Severe complications of circumcision: an analysis of 48 cases. J Pediatr Urol 2007; 3 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 8 Sebaratnam DF. Circumcision in the paediatric patient: a review of indications, technique and complications. J Paediatr Child Health 2018; 54 (12) 1404
    CrossrefPubMedGoogle Scholar
  • 9 Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg 2006; 93 (07) 885-890
    CrossrefPubMedGoogle Scholar
  • 10 Christensen-Szalanski JJ, Boyce WT, Harrell H, Gardner MM. Circumcision and informed consent. Is more information always better?. Med Care 1987; 25 (09) 856-867
    CrossrefPubMedGoogle Scholar
  • 11 Both N. British Medical Association. The law and ethics of male circumcision: guidance for doctors. J Med Ethics 2004; 30 (03) 259-263
    CrossrefPubMedGoogle Scholar
  • 12 Elliston S. The Best Interests of the Child in Healthcare. New York, NY: Routledge-Cavendish; 2007
    CrossrefGoogle Scholar
  • 13 Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol 2013; 190 (04) 1271-1274
    CrossrefPubMedGoogle Scholar
  • 14 Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol 2010; 10: 2
    CrossrefPubMedGoogle Scholar
  • 15 Fahmy MA. Prevalence of male circumcision complications. In: Complications in Male Circumcision. Philadelphia, PA: Elsevier; 2019: 49-63
    CrossrefGoogle Scholar
  • 16 Persad R, Sharma S, McTavish J, Imber C, Mouriquand PD. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Br J Urol 1995; 75 (01) 91-93
    CrossrefPubMedGoogle Scholar
  • 17 Homer L, Buchanan KJ, Nasr B, Losty PD, Corbett HJ. Meatal stenosis in boys following circumcision for lichen sclerosus (balanitis xerotica obliterans). J Urol 2014; 192 (06) 1784-1788
    CrossrefPubMedGoogle Scholar
  • 18 Morris BJ, Krieger JN. Does circumcision increase meatal stenosis risk?—a systematic review and meta-analysis. Urology 2017; 110: 16-26
    CrossrefPubMedGoogle Scholar
  • 19 Barbagli G, Palminteri E, Mirri F, Guazzoni G, Turini D, Lazzeri M. Penile carcinoma in patients with genital lichen sclerosus: a multicenter survey. J Urol 2006; 175 (04) 1359-1363
    CrossrefPubMedGoogle Scholar
  • 20 Yardley IE, Cosgrove C, Lambert AW. Paediatric preputial pathology: are we circumcising enough?. Ann R Coll Surg Engl 2007; 89 (01) 62-65
    CrossrefPubMedGoogle Scholar
  • 21 Green PA, Bethell GS, Wilkinson DJ, Kenny SE, Corbett HJ. Surgical management of genitourinary lichen sclerosus et atrophicus in boys in England: A 10-year review of practices and outcomes. J Pediatr Urol 2012; 15 (01) 45.e1-45.e5
    CrossrefPubMedGoogle Scholar
  • 22 Pearce I, Payne SR. Do men having routine circumcision need histological confirmation of the cause of their phimosis or postoperative follow-up?. Ann R Coll Surg Engl 2002; 84 (05) 325-327
    CrossrefPubMedGoogle Scholar
  • 23 Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002; 7 (03) 329-343
    CrossrefPubMedGoogle Scholar
  • 24 Rai BP, Qureshi A, Kadi N, Donat R. How painful is adult circumcision? A prospective, observational cohort study. J Urol 2013; 189 (06) 2237-2242
    CrossrefPubMedGoogle Scholar
  • 25 Voznesensky M, Mutter C, Hayn M, Kinkead T, Jumper B. Pediatric sutureless circumcision: an effective and cost efficient alternative. Can J Urol 2015; 22 (05) 7995-7999
    PubMedGoogle Scholar
  • 26 Kacker S, Frick KD, Gaydos CA, Tobian AA. Costs and effectiveness of neonatal male circumcision. Arch Pediatr Adolesc Med 2012; 166 (10) 910-918
    CrossrefPubMedGoogle Scholar