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

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

Publikationsverlauf

Eingereicht: 29. April 2020

Angenommen: 14. September 2020

Artikel online veröffentlicht:
14. Dezember 2020

• 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
• 2 Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 2006; 6: 21
• 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
• 4 Morris BJ, Krieger J. Non-therapeutic male circumcision. Paediatr Child Health 2020; 30: 102-107
• 5 Beecham L. GMC issues guidelines on circumcision. BMJ 1997; 314 (7094): 1573
• 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
• 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
• 8 Sebaratnam DF. Circumcision in the paediatric patient: a review of indications, technique and complications. J Paediatr Child Health 2018; 54 (12) 1404
• 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
• 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
• 11 Both N. British Medical Association. The law and ethics of male circumcision: guidance for doctors. J Med Ethics 2004; 30 (03) 259-263
• 12 Elliston S. The Best Interests of the Child in Healthcare. New York, NY: Routledge-Cavendish; 2007
• 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
• 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
• 15 Fahmy MA. Prevalence of male circumcision complications. In: Complications in Male Circumcision. Philadelphia, PA: Elsevier; 2019: 49-63
• 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
• 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
• 18 Morris BJ, Krieger JN. Does circumcision increase meatal stenosis risk?—a systematic review and meta-analysis. Urology 2017; 110: 16-26
• 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
• 20 Yardley IE, Cosgrove C, Lambert AW. Paediatric preputial pathology: are we circumcising enough?. Ann R Coll Surg Engl 2007; 89 (01) 62-65
• 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
• 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
• 23 Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002; 7 (03) 329-343
• 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
• 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
• 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