Are mechanical and chemical trauma the reason of meatal stenosis after newborn circumcision?

Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up

BACKGROUND

Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions.

AIM

This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device.

METHODS

This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7-17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis.

RESULTS

Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026).

CONCLUSION

The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.

Is frenuloplasty a risk factor for post-circumcision meatal stenosis?

INTRODUCTION

Meatal stenosis (MS) is a common complication of circumcision. In this study, we aimed to examine the role of frenuloplasty in the development of MS in school-age boys undergoing circumcision.

MATERIALS AND METHODS

Medical data of 502 patients who were circumcised surgically in the hospital setting aged ≥6 years between July 2019 and July 2020 were retrospectively analyzed. The patients were divided into two groups based on the appearance of the frenular region. The patients whose integrity of the frenular region was protected during circumcision were classified as Group 1 (n = 262), and the patients whose frenulum was absent for some reason were classified as Group 2 (n = 240). Both groups were evaluated based on the development of complications following frenuloplasty after circumcision.

RESULTS

The median age was 11 (range: 6 to 17) years. The median circumcision age was seven (range: 6 to 12) years, and the median time since circumcision was four (range: 1 to 11) years. The main complaints of the patients were gastrointestinal (n = 254, 51%), respiratory (n = 148, 29%), and urinary system-related pathologies (n = 100, 20%). Meatal stenosis was the most common complication of circumcision with an overall incidence of 4%, which was significantly higher in Group 2 (7% vs. 2%, respectively; p = 0.006).

CONCLUSION

Our results suggested that MS is a common complication of circumcision. Performing frenuloplasty during circumcision might increase the risk of developing MS in school-age boys.

Prevalence and causes of meatal stenosis in circumcised boys

INTRODUCTION

The prevalence of meatal stenosis after circumcision remains unclear, and its causes are unknown.

OBJECTIVE

To know the prevalence and the causes of meatal stenosis after circumcision in boys.

STUDY DESIGN

Between October 2018 and April 2019, we carried out a prospective cross-sectional study on 1031 circumcised boys, aged 5-8 years (mean age 6.1 years ± 0.3 years), enrolled in the first level of primary school. All enrolled children underwent genitourinary examination. Moreover, an anonymous questionnaire was filled-in by one of the parents.

RESULTS

The screening revealed the presence of meatal stenosis in 185 children, representing a prevalence of 17.9% of cases (95% CI = 15.6-20.3). Analysis of the results using both the univariate and multivariate mode brought out some common risk factors such as a foreskin that completely adheres to the glans with forceful retraction of the prepuce and the use of a healing product: Beta-sitosterol and Hydrocotyl (Centella Asiatica), rarely Trolamine. In addition, this study showed that boys circumcised during their first week of life are twice as likely to develop meatal stenosis than those circumcised between 7 and 12 months (OR = 2.08; 95% CI = 1.10-3.92, p = 0.021).

DISCUSSION

We believe that when the foreskin is fully attached to the glans, forced retraction of the prepuce most often causes a loss of the mucous membrane that covers the glans, making the glans less resistant to chemical attack, and therefore may play an important role in the development of meatal stenosis. However, This study is limited by the absence of a cohort of uncircumcised boys for comparison to see if the small diameter of the meatus is also present in this group.

CONCLUSIONS

This study showed that stenosis of the urethral meatus is a frequent complication of circumcision. Circumcision in the first week of life, complete adhesion of the foreskin to the glans, and the use of a healing product were associated with the risk of stenosis development.

Systematic review of complications arising from male circumcision

Background

Neonatal male circumcision is the most common procedure performed on paediatric patients (Simpson et al., 2014) and one of the most common surgical procedures in the world (American Academy of Pediatrics, 2012).

Methods

A search was conducted for articles about complications arising from male circumcision surgeries by entering the term ‘male circumcision’ into PubMed on June 16, 2020. Six thousand six hundred forty‐one articles published from 1945 to 2020 were found. Seventy‐eight articles were ultimately selected for the systematic review.

Results

The 78 articles selected from the literature search were entered into one of three tables. The first table includes 15 articles pertaining to chart reviews and cohort studies and report complication rates. The second table reports specific complications from 51 case reports and case series, and the third table is a summary from 12 articles regarding physician questionnaires and society recommendations. Additionally, the 78 articles were used to compile a list of 47 specific complications arising from male circumcision surgeries.

Conclusions

Complications from neonatal male circumcisions are common and healthcare providers need to be better informed of the potential complications of the surgery so that they can more effectively counsel their patients about potential risks, likelihood of complications and what can be done to prevent them. While experienced providers who practice in sterile settings have better outcomes with fewer complications, encouraging parents to take into account who is performing their son's circumcision, what was their training, how clean is their practice and how much experience they have and reminding them they have the option to decline the procedure entirely allow the parents to get a more complete picture and play an essential role in the decision‐making process.

Meatal stenosis posttraditional neonatal circumcision-cross-sectional study

Context:

Circumcision holds a unique place in the daily practice of urology. Heat cautery device is the most common local technique used, we found it can cause meatal stenosis (MS) and its sequels.

Aim:

The study aims to determine the incidence, presenting symptoms of MS and its relation to local traditional neonatal circumcision techniques among our children.

Settings and Design:

This study was retrospectively study.

Materials and Methods:

A total of 150 children who circumcised during the infancy period, outside medical institutes, and they circumcised using local traditional techniques either heating cautery devices or surgical knives.

Statistical Analysis:

Of data were carried out using the Statistical Packages for the Social Sciences - version 25 (IBM Corporation).

Results:

Of 150 children, 60 (40%) had MS. The mean age at the time of diagnosis was 5.98 ± 3.06 years (range 1–13 years) and the majority of patients were within the age group of 5–9 years (n = 31, 51.7%), median 6.0 years. The incidence of MS was significantly higher (P = 0.037) among a group of children circumcised with a heating device in comparison with the circumcised group with other methods. Forty-six children (76.7%) were symptomatic and fourteen children (23.3%) diagnosis of MS had performed incidentally.

Conclusions:

MS is a long-term complication of neonatal circumcision with a late presentation and sequels. It is more common among group circumcised using heating cautery. We recommend using heating cautery cautiously.