Complications of circumcision
- Jenny H Yiee, MD
Jenny H Yiee, MD
- Assistant Clinical Professor
- University of California, Urvine
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Martin I Lorin, MD
Martin I Lorin, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Duncan Wilcox, MD
Duncan Wilcox, MD
- Section Editor — Pediatric Urology
- Professor of Urology, The Ponzio Family Chair in Pediatric Urology
- University of Colorado
Circumcision in the male refers to the surgical removal of the foreskin (ie, prepuce) of the penis. The procedure is centuries old and continues to be performed for a variety of religious, cultural, and medical reasons. Debate continues as to the utility of circumcision, The 2012 American Academy of Pediatrics (AAP) policy statement regarding newborn circumcision states, preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure," but did not recommend it for all newborns, instead leaving the decision to each parent . Despite this controversy, circumcision is the most common operation in the United States. A survey in 1992 showed 77 percent of US-born men to be circumcised and 42 percent of non-United States born men to be circumcised .
Complications of circumcision and their management will be reviewed here. Circumcision technique and its risks and benefits are discussed separately. (See "Techniques for neonatal circumcision" and "Neonatal circumcision: Risks and benefits".)
Careful, meticulous attention to penile anatomy (figure 1) and the correct use of surgical equipment by trained clinicians can prevent most complications from circumcision.
The rate of procedure-related complications during and after circumcision in the neonate is approximately 2 to 6 per 1000 [3-5]. This rate increases 20-fold for boys who are circumcised between one and nine years of age, and 10-fold for those circumcised after 10 years of age . Inadequate training of clinicians contributes to complications, as practitioners without formal training may not recognize congenital malformations (eg, congenital buried penis and penoscrotal webbing) that are more likely to result in poor results when using routine conventional methods (picture 1 and picture 2) . Patients with these abnormalities should be referred to a pediatric urologist.
Most of these problems are readily treatable and cause no long-term effects. However, when complications occur, especially surgical complications, specialist referral may be required for evaluation and reoperation.
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- MEDICAL COMPLICATIONS
- - Management
- SURGICAL COMPLICATIONS
- Urethral complications
- - Urethrocutaneous fistulas
- - Meatal stenosis
- Glans injury
- Excessive skin removal
- Too little skin removed
- Epidermal inclusion cyst
- Scarring complications
- - Minor adhesions
- - Skin bridges
- - Cicatrix
- Anesthetic complications
- INFORMATION FOR PATIENTS