Speciality
Spotlight

 




 


Neonatal & Perinatal


    

 




Circumcision

  

  • Abstract  

    Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. 

       


    Penile Problems 

    Penile problems may develop in both circumcised and uncircumcised males. A retrospective survey conducted at two inner city clinics asked parents of boys 4 months to 12 years of age to recall whether their sons had ever developed any penile problems. Although parents of uncircumcised boys reported an increased number of medical visits for penile problems, the frequency of balanitis and irritation was not significantly different between circumcised and uncircumcised boys. In addition, most of the problems reported were minor. Case reports suggest an increased frequency of paraphimosis in uncircumcised elderly men who require intermittent or chronic bladder catheterization. Other case reports indicate that balanitis occurs more frequently in uncircumcised men than in circumcised men and suggest an increased frequency of balanitis in men with diabetes and in uncircumcised soldiers during wartime.

      


    Chronic inflammation of the foreskin may result in a secondary phimosis caused by scarring, Medical therapy has been successful in resolving both secondary phimosis and paraphimosis, but surgical intervention is sometimes indicated. 

       


    Complications of the Circumcision Procedure

    The true incidence of complications after newborn circumcision is unknown. Reports of two large series have suggested that the complications rate is somewhere between 0.2% and 0.6%. Most of the complication that do occur are minor. The most frequent complication, bleeding, is seen in –0.1% of circumcisions. But most of these infections 

    are minor and are manifest only by some local redness and purulence. There also are isolated case reports of other complications such as recurrent phimosis, wound seperation, concealed penis, unsatisfactory cosmesis because of excess skin, skin bridges, urinery retention, meatitis, metal stenosis, chordee, inclusion cysts, and retained Plastibell devices. 

       


    Circumstances After the Newborn Period

    Should circumcision become necessary after the newborn period because problems have developed, general anesthesia is often used and requires a more formal surgical procedure necessitating hemostasis and suturing of skin edges. There is morbidity in the form of time lost from school or work to be considered.

       


    Analgesia

    There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress and hence some sort of local anesthetic should be used for this procedure.



    Circumcision Status and UTI in Infant Males

    All studies have been shown an increased risk of UTI in uncircumcised males, with the greatest risk in infants younger than 1 year of age.



    Although all these studies have shown an increased risk of UTI in uncircumcised male infants, it is difficult to summarize and compare the results because of differences in methodology, samples of infants studied, determination of circumcision status, method of urine collection, UTI definition, and assessment of confounding variables such as prematurity breastfeeding etc. Few of the studies have looked at potential cofounders such as prematurity, breastfeeding, and method of urine collection. Breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. 



    There is a biologically plausible explanation for the relationship between an intact foreskin and an increased association of UTI during infancy. Increased periurethral bacterial colonization may be a risk factor for
    UTI. 

      


    Using numbers from the literature, one can estimate that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants. Although the relative risk of UTI in uncircumcised male infants compared with circumcised male infants is increased from 4- to as much as 10-fold during the first year of life, the absolute risk of developing a UTI in an uncircumcised male infant is low ( at most, – 1%).

      


    Circumcision Status and Cancer of the Penis

    An annual penile cancer rate of 0.9 to 1.0 per 100 000 translates to 9 to 10 cases of penile cancer per year per 1 million men. Although the risk of developing penile cancer in an uncircumcised man compared with a circumcised man is increased more than threefold, it is difficult to estimate accurately the magnitude of this risk based on existing studies.

      


    Circumcision Status and STD including Human Immunodeficiency Virus (HIV)

    Studies suggest that circumcised males may be less at risk for syphilis than are uncircumcised male. In addition, there is substantial body of evidence that links noncircumcision in men with the risk for HIV infection. However, behavioral factors appear to be far more important risk factors in the acquisition of HIV infection than circumcision status.

        

 



 

 

Speciality Spotlight

 

 

Circumcision
  

  • Abstract  
    Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. 
       
    Penile Problems 
    Penile problems may develop in both circumcised and uncircumcised males. A retrospective survey conducted at two inner city clinics asked parents of boys 4 months to 12 years of age to recall whether their sons had ever developed any penile problems. Although parents of uncircumcised boys reported an increased number of medical visits for penile problems, the frequency of balanitis and irritation was not significantly different between circumcised and uncircumcised boys. In addition, most of the problems reported were minor. Case reports suggest an increased frequency of paraphimosis in uncircumcised elderly men who require intermittent or chronic bladder catheterization. Other case reports indicate that balanitis occurs more frequently in uncircumcised men than in circumcised men and suggest an increased frequency of balanitis in men with diabetes and in uncircumcised soldiers during wartime.
      
    Chronic inflammation of the foreskin may result in a secondary phimosis caused by scarring, Medical therapy has been successful in resolving both secondary phimosis and paraphimosis, but surgical intervention is sometimes indicated. 
       
    Complications of the Circumcision Procedure
    The true incidence of complications after newborn circumcision is unknown. Reports of two large series have suggested that the complications rate is somewhere between 0.2% and 0.6%. Most of the complication that do occur are minor. The most frequent complication, bleeding, is seen in –0.1% of circumcisions. But most of these infections 
    are minor and are manifest only by some local redness and purulence. There also are isolated case reports of other complications such as recurrent phimosis, wound seperation, concealed penis, unsatisfactory cosmesis because of excess skin, skin bridges, urinery retention, meatitis, metal stenosis, chordee, inclusion cysts, and retained Plastibell devices. 
       
    Circumstances After the Newborn Period
    Should circumcision become necessary after the newborn period because problems have developed, general anesthesia is often used and requires a more formal surgical procedure necessitating hemostasis and suturing of skin edges. There is morbidity in the form of time lost from school or work to be considered.
       
    Analgesia
    There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress and hence some sort of local anesthetic should be used for this procedure.

    Circumcision Status and UTI in Infant Males
    All studies have been shown an increased risk of UTI in uncircumcised males, with the greatest risk in infants younger than 1 year of age.

    Although all these studies have shown an increased risk of UTI in uncircumcised male infants, it is difficult to summarize and compare the results because of differences in methodology, samples of infants studied, determination of circumcision status, method of urine collection, UTI definition, and assessment of confounding variables such as prematurity breastfeeding etc. Few of the studies have looked at potential cofounders such as prematurity, breastfeeding, and method of urine collection. Breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. 

    There is a biologically plausible explanation for the relationship between an intact foreskin and an increased association of UTI during infancy. Increased periurethral bacterial colonization may be a risk factor for UTI. 
      
    Using numbers from the literature, one can estimate that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants. Although the relative risk of UTI in uncircumcised male infants compared with circumcised male infants is increased from 4- to as much as 10-fold during the first year of life, the absolute risk of developing a UTI in an uncircumcised male infant is low ( at most, – 1%).
      
    Circumcision Status and Cancer of the Penis
    An annual penile cancer rate of 0.9 to 1.0 per 100 000 translates to 9 to 10 cases of penile cancer per year per 1 million men. Although the risk of developing penile cancer in an uncircumcised man compared with a circumcised man is increased more than threefold, it is difficult to estimate accurately the magnitude of this risk based on existing studies.
      
    Circumcision Status and STD including Human Immunodeficiency Virus (HIV)
    Studies suggest that circumcised males may be less at risk for syphilis than are uncircumcised male. In addition, there is substantial body of evidence that links noncircumcision in men with the risk for HIV infection. However, behavioral factors appear to be far more important risk factors in the acquisition of HIV infection than circumcision status.
        

 

 

By |2022-07-20T16:41:26+00:00July 20, 2022|Uncategorized|Comments Off on Circumcision

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