Amputation of penis after circumcision--penoplasty using expandable prosthesis

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.

Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits 'justify access to this procedure for families who choose it,' claiming that whenever and for whatever reason it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given.

Late complications of newborn circumcision: a common and avoidable problem

PURPOSE

The purpose of this paper is to study the types of operative and post-operative late complications resulting from newborn circumcisions and to make recommendations to prevent them.

METHODS

After obtaining IRB approval, a retrospective review of the late complications resulting from newborn circumcisions treated at the MassGeneral Hospital for Children from January 2003 to December 2007 was undertaken. The source used was the consultation notes and operative reports of affected patients. Additionally, cases seen in the outpatient Pediatric Urology Clinic from April 2007 to April 2008 were reviewed.

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.

Dislocation of hip in myelomeningocele. The McKay hip stabilization

We reviewed the clinical and radiographic results of varus osteotomy of the proximal aspect of the femur and transfer of the adductor and external oblique muscles (the McKay procedure) in thirty-four children (sixty-six hips) who had an unstable hip secondary to a myelomeningocele at the middle or caudad lumbar level. the average age at the time of the operation was twenty months (range, seven to forty-two months). The average duration of follow-up was 10.9 years (range, 0.7 to 20.0 years). An open reduction was performed in ten hips. None of the children had had any previous operative treatment. The index operation helped to maintain the stability of thirty-seven of the fifty-one hips twenty-six children who remained neurologically stable: seventeen of nineteen hips that were at risk, two of three hips with acetabular dysplasia, fifteen of sixteen subluxated hips, one of three dislocated hips that had been previously reduced with a Pavlik harness, one of two dislocatable hips, and one of seven previously untreated dislocated hips. The index operation was not successful for one dislocated hip that had been treated with closed reduction and application of a spica cast. The operation was a success for eight of the fifteen hips in eight children who had a progressive loss of neurological function: three of five hips that were at risk, one hip with acetabular dysplasia, two of four subluxated hips, one of two that had been previously reduced with a Pavlik harness, and one dislocatable hip. Two dislocated hips redislocated. Initially the index operation was performed on all children who had a myelomeningocele at the third or fourth lumbar level. Recent data have shown that the hips in these children are not all at risk, and we now perform the operation only if there is documented instability of the hip.