Pubmed circumcision complications, severe complications and more

as you may have noticed I do a lot of cut and paste from other sources. Maybe I’m not original or maybe I’m lazy, but I figure if someone can get the point across better and more articulately than me, I might as well let them say it. I do a lot of copy/paste so that I can tag and label it so that maybe just maybe it will pop up easier in the Internet search engines…. And in case you were wondering I am totally against circumcising babies and children without immediate medical need. I have no problem with an adult choosing genital modification surgeries

http://www.ncbi.nlm.nih.gov/m/pubmed/11150473/

CONCLUSIONS: Genitourinary trauma in the newborn is rare but often necessitates significant surgical intervention. Circumcision often is the causative event. There has been only 1 prior report of a perineal injury similar to case 7, with a fatal outcome.

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Infant pain measured during circumcision

http://lib.bioinfo.pl/paper:9925869

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Some statistics of complications for on study group…
http://www.biomedcentral.com/1471-2490/6/21/

Results
Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051).

Conclusion
We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.

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The scientific world journal
http://www.tswj.com/2011/373829/

ABSTRACT

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

…..

The rate of adverse events varies widely across reports, depending on the definition chosen for a postoperative complication. In a large meta-analysis of prospective and retrospective series, Weiss et al. reported a frequency of adverse events of and for serious adverse events [14]. This can represent a significant cost in terms of utilization resources and healthcare dollars. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. This translated to an average total cost per patient for redo procedures of $1,617 and an estimated annual cost of $137,122 to the institution [15].

For ease of discussion, adverse events following circumcision can be categorized as either early or late complications. Early complications such as: bleeding, pain, inadequate skin removal, and surgical site infection tend to be minor and quite treatable. However, postcircumcision bleeding in patients with coagulation disorders can be significant and sometimes even fatal. Other serious early complications include chordee, iatrogenic hypospadias, glanular necrosis, and glanular amputation. The latter, of course, requires prompt surgical intervention. Late complications include epidermal inclusion cysts, suture sinus tracts, chordee, inadequate skin removal resulting in redundant foreskin, penile adhesions, phimosis, buried penis, urethrocutaneous fistulae, meatitis, and meatal stenosis. These are commonly treated in an outpatient setting. Most of the aforementioned conditions are avoidable giving attention to detail and proper technique. Mayer et al. found that some subtle anatomic variations are significantly associated with late circumcision complications, including penoscrotal webbing, suprapubic fat pads, and prematurity [16].

4.1. Death

Fortunately, death from neonatal circumcision is fortunately an extremely rare occurrence. King reported a period when 500,000 consecutive circumcisions were performed in New York city without a single fatality [17]. However, a case of a misplaced Plastibell ring which caused complete meatal obstruction resulted in acute venous stasis and subsequent death from sepsis reported by the Ontario Pediatric Death Review Committee in 2007. In this situation, prompt recognition of the obstruction is critical and primary management should be immediate removal of the Plastibell ring and catheter placement [18]. There are other reports in the international literature that describe mortalities from tetanus as a result of circumcisions performed under nonsterile conditions. Bennett et al. reported that topical antibiotics could decrease this risk of neonatal tetanus 4-fold [19].

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Necrosis of the glans can occur as a result of cautery injury during a Gomco circumcision or from distal migration of an incorrectly sized Plastibell ring [9, 20]. Management of glans necrosis depends on its severity

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I know the examiner is a dubious source…..

http://www.examiner.com/article/circumcision-s-complications-what-could-go-wrong

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http://www.sch.edu.au/health/factsheets/joint/?circumj.htm

Some research in North America has shown that boys, who were circumcised as small babies, have less chance of developing urinary tract infections in the first year of life than those who are uncircumcised (there is no difference in older boys). However, the numbers of uncircumcised boys who will get urinary infections is small. If 1000 well boys are circumcised, 8 infections will be prevented, but 20 will have a complication related to the circumcision. So the risks of circumcision surgery outweigh the benefits. In those boys with an underlying urinary tract problem, circumcision has been shown to reduce the risk of recurrent urinary tract infections, particularly if still in nappies.

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Even with the most skilled and careful hands there are small incidence of risks from both the operation and the general anaesthesia. There is a risk of bleeding and infection following the operation. The risk of death or serious disability due to general anaesthesia is 1:80 000. Very rarely the penis may be permanently damaged. After circumcision, irritation of the exposed penis tip can cause narrowing of the urine opening (meatal stenosis) that may require further surgery. About 5% of children who have been circumcised require further surgery to correct problems it causes.

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http://www.jpurol.com/article/S1477-5131(06)00053-2/abstract
http://www.jpurol.com/article/S1477-5131(06)00053-2/abstract

The most commonly observed complication was preputio-glandular fusion, seen in 25 cases (52%). The other complications were: meatal stenosis in 11 (23%), urethral fistula in five (10.4%), partial glandular amputation in four (8%) and opening distal urethra in three (6%). Adhesion freeing and revision were performed in all cases of preputio-glandular fusion, patients with meatal stenosis underwent meatotomy, urethral fistulae were repaired by simple closure, partial glans amputations were patched with buccal mucosa, and patients with complete open distal urethra were repaired by Mathieu (one patient) and tubularized incised plate urethroplasty techniques.

Conclusion
Circumcision may be associated with many serious complications. To prevent these complications, the operation should be performed by educated and experienced personnel.

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http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html

Obtaining informed consent for medical procedures is an important practice. In emergent cases when a parent or legal guardian is not available to give consent, a procedure will often be performed if it is judged to be life-sustaining and in the best interest of the patient. When a person having a procedure is unable to give consent and a guardian is present, the guardian’s consent is acceptable. This occurs for routine medical procedures of clear benefit to children such as immunizations. A physician performing a procedure for other than medical reasons on a nonconsenting patient raises ethical concerns.

While routine circumcision is widely practiced, the small medical benefits of circumcision lead many to consider routine circumcision to be a cosmetic procedure. This leads to questions regarding medical ethics and whether and how to present to a parent a balanced discussion of the relative benefits and harms of the procedure. Key to the ethical discussion is respect of the parent’s religious, ethnic, or other cultural beliefs for which circumcision is practiced.

ECONOMIC ANALYSIS
One cost-effectiveness analysis estimated that the lifetime cost difference for men who were circumcised was $25, with a benefit of 10 additional days of life. (30) Another analysis estimated that routine circumcision cost $102 per person, resulting in 14 hours of extended life. (31) These findings suggest that cost factors should be removed from the decision of circumcision. (4)

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http://www.springerlink.com/content/9w834626551u8087/

Results
A total of 8,967 children were operated during the study period, of which 424 (4.7%) were for complications resulting from previous neonatal circumcision. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications. At the outpatient clinic of the Section of Pediatric Urology, 127 boys with concerns following newborn circumcision were evaluated, representing 7.4% of the total volume of cases seen in this clinic.
Conclusions
Our results indicate the need to undertake a collaborative study to define the incidence of complications following newborn circumcisions, which should be performed by practitioners with adequate training in the technique of their choice and its post-operative care.

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http://www.avvo.com/legal-guides/ugc/botched-circumcision—what-to-do-when-your-sons-circumcision-goes-wrong

Medical malpractice attorney:

6
Why Was I Not Warned About the Risks?
It is an unfortunate fact that doctors often do not fully discuss the risks and disadvantages of circumcision with parents or their patients before obtaining consent for the operation. Too often circumcision is viewed as a minor surgery. [Of course, the definition of minor surgery is that which is done on another, while major surgery is that which is done on oneself!] The fact is that in most states the parents of a baby boy or the man about to undergo a circumcision are entitled to be fully informed about the risks and disadvantages. If such is not done, circumcision is performed, and a reasonable person would not have consented if told about the risks and disadvantages, then a suit may be brought for “lack of informed consent.”

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20120930-132251.jpg

20121110-205759.jpg

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below is a link to pictures of a circumcision…. Look at it and realize this torture is happening to a child
http://assets4.pinimg.com/upload/295971006731352403_q5BmioSt.jpg

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2 thoughts on “Pubmed circumcision complications, severe complications and more

  1. Circumcision may be associated with many serious complications. To prevent these complications, the operation should be performed by educated and experienced personnel.

    If the subject under discussion were any other form of nonconsensual cosmetic surgery, the above sentence would read as follows:

    “Circumcision may be associated with many serious complications. To prevent these complications, the operation should not be performed.

    But baby boys, and baby boys alone, have no right to bodily integrity, security of person, or the equal protection of the laws. The imaginary dictate of an imaginary supernatural obscenity trumps all of the above.

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