A comprehensive comparison of the early and late complications of surgical circumcision in neonates and children: A cohort study

Abstract

Background and Aims Major circumcision complications are rare; however, circumcision arouses distress in some special cases. The present study aimed to compare infancy and childhood regarding the frequency and relative risk of early and late complications of circumcision. Methods This study was a retrospective cohort data analysis including 240 neonates and 240 children referred for circumcision from 2015 to 2021. All circumcisions were performed using the surgical dorsal‐ventral slits method. A Cox proportional hazard model was used to assess the relative risk (RR) of complications at a confidence Interval of 95%. Results The mean age was 19.32 ± 6.5 days for the neonates and 46.1 ± 8.8 months for the children. In general, complications occurred in 61 boys (12.7%), 40 neonates (8.3%), and 21 children (4.4%) ( p ˂0.001). Bleeding was the most common early complication in six neonates (2.5%) and three children (1.3%), and meatal stenosis was the most common late complication in 10 neonates (4.2%) and four children (1.6%). Meatal web was observed in 11 neonates (4.6%) and four children (1.6%), and the incomplete removal of the prepuce, as “not very satisfactory”, was also noticed in nine neonates (3.75%) and three children (1.3%). The circumcision complications were significantly more frequent in neonates than in children (RR = 2.6, 95% CI 1.46‐4.71, p <0.001). The neonatal circumcisions had a significant risk of the incomplete removal of the prepuce, meatal web, and meatal stenosis compared to children (RR = 3, 95% CI 5.83–10.81, p <0.04; RR = 2.75, 95% CI 0.9–8.3, p ˂0.03; RR = 2.5, 95% CI 0.8–7.75, p <0.04, respectively). Conclusion The risk of complications is higher in neonates than children. The incomplete removal of prepuce, meatal web, and meatal stenosis are significantly higher in neonates than in children. Before prohibiting or recommending this procedure, practitioners should provide comprehensive information about its risks and benefits. Parents should weigh up the risks and benefits and make the best decision regarding their personal beliefs and customs.

Characteristics and management of post‐circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon

“…The mean time between circumcision and the onset of symptoms was 3.68 ± 1.56 months and ranged from 1 to 6 months. Eight with a mean time to removal of 10.28 ± 1.17 days (10)(11)(12)(13)(14)(15). The average hospital stay was 9.65 ± 1.43 days (3)(4)(5)(6)(7)(8)(9)(10).…”

“…Eight with a mean time to removal of 10.28 ± 1.17 days (10)(11)(12)(13)(14)(15). The average hospital stay was 9.65 ± 1.43 days (3)(4)(5)(6)(7)(8)(9)(10). The mean time from diagnosis to surgery was 3.88 ± 1.72 years (1-13).…”

“…Osifo and Takure in Nigeria also reported a frequency of post-circumcision urethrocutaneous fistulas that reached 21.1% and 74% of their cases, in Benin city and Ibadan, respectively. 11,19 The complications of circumcision are more often minor than major 10 ; this is the case for UCF, which most of the time requires surgical repair. Although none of the cases in our series were premature, but had their circumcision during their first birthday, UCF is the result of damaging the urethral wall by cutting, crushing, or suturing.…”

“…Complications related to circumcision vary from one study to another, reaching up to 21% 10,11 . There is controversy about the complication rates of neonatal and early childhood circumcision; while some authors report a high rate of circumcision complications in newborns, 10,12 other studies have shown an increased frequency of circumcision complications in children 13,14 .…”

An overview of circumcision and a modification that prevents glans injuries and cosmetic problems in circumcisions made with the guillotine technique

“…Among our 2853 cases of the surgical approach for circumcisions, there were no single gland injuries which could result from conventional methods of performing it. Therefore, an analysis of the literature shows that the MGT can reduce signi cantly one of the most important complications associated with circumcision through zero incidence compared to other studies (13). Moreover, minor problems have the same rates between MGT and other techniques, meaning that changes do not add risks, thus keeping its safety as it was designed (14).…”