Glans amputation during routine neonatal circumcision: Mechanism of injury and strategy for prevention

Salle, João L. Pippi; Jesus, Lisieux Eyer de; Lorenzo, Armando J.; Romao, Rodrigo; Figueroa, Víctor; Bägli, Darius; Reda, Edward F.; Koyle, Martin A.; Farhat, Walid A.

doi:10.1016/j.jpurol.2012.09.012

Cited by 35 publications

(26 citation statements)

References 16 publications

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“…Although we did not observe any injury to the glans in our study, partial amputation of the glans has been reported with the Mogen clamp 23-25 . We did not observe excess bleeding with the Plastibell, but this too has been reported 16 .…”

Section: Discussioncontrasting

confidence: 81%

A Randomized Trial of Mogen Clamp Versus Plastibell for Neonatal Male Circumcision in Botswana

Plank

Ndubuka²,

Wirth

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Male circumcision can reduce the risk of heterosexually-acquired HIV-1 infection in men. Neonatal male circumcision (NMC) has many potential advantages over circumcision at older ages but little is known about its feasibility and safety in resource-limited settings. Methods We performed a randomized trial in southeastern Botswana of Mogen clamp and Plastibell, two commonly used devices for NMC. Follow-up visits occurred at six weeks and four months postpartum. Adverse events, parental satisfaction and staff impressions were recorded. Results Of 302 male neonates randomized, 300 (99%) underwent circumcision, 153 (51%) with Mogen clamp and 147 (49%) with Plastibell. There were no major adverse events in the Mogen clamp arm but there were two major adverse events in the Plastibell arm (both were a proximally migrated ring that had to be removed by study staff). Minor adverse events were more common with the Mogen clamp compared with the Plastibell, specifically removal of too little skin and formation of skin bridges or adhesions (12 vs. 1 and 11 vs. 3, respectively, all P<0.05). Five (3%) infants in the Mogen clamp arm and none in the Plastibell arm had minor bleeding (P=0.03). More than 94% of mothers reported being highly or completely satisfied with the procedure. Conclusions NMC can be performed in Botswana with a low rate of adverse events and high parental satisfaction. Although the risk of migration and retention of the Plastibell is small, the Mogen clamp may be safer for NMC in regions where immediate emergent medical attention is not available.

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Section: Discussioncontrasting

confidence: 81%

A Randomized Trial of Mogen Clamp Versus Plastibell for Neonatal Male Circumcision in Botswana

Plank

Ndubuka²,

Wirth

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Previous literature has reported a wide range of complications, ranging from 0.1% to 35%. 7 Our low complication rate could be explained by the fact that the surgeons were experienced in the applied techniques.…”

Section: Discussionmentioning

confidence: 90%

Examination of short and long term complications of thermocautery, plastic clamping, and surgical circumcision techniques

Tuncer¹,

Erten²

2017

Pak J Med Sci

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Objective:In this study, thermocautery, plastic clamping, and conventional (open surgical) circumcision techniques were compared in terms of their complications.Methods:Male patients who underwent circumcisions between May 2014 and May 2015 in two separate pediatric surgery clinics were retrospectively analyzed using the hospital registry system. These patients were evaluated in terms of age, accompanying pathologies, anesthesia techniques, complication rates, duration of surgery, and circumcision techniques. A statistical analysis of the data was performed, with a P<0.05 considered to be statistically significant.Results:The patients were divided into three groups according to the circumcision method: conventional surgical circumcision (n=833), thermocautery (n=1011), and plastic clamp (n=218). Complications were observed in 21 cases (1%): bleeding (11), infection (2), trapped penis (6), meatitis (1), and scrotal injury (1). There were significantly fewer complications in the thermocautery technique when compared to the clamping and surgical circumcision techniques. The plastic clamping and thermocautery techniques were superior to a surgical circumcision in terms of the operation time.Conclusion:The thermocautery circumcision technique can be used easily in both the operating theatre and in designated circumcision rooms, with a lower complication rate, when compared to plastic clamping and surgical circumcisions.

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“…Previous reports of severe circumcision-related injuries have speculated on possible mechanisms of these injuries. Insufficient lysis of adhesions is one of those mechanisms that has been implicated [3]. Persistent adhesions may also very well lead to scrotal injuries, since tension applied to the preputial skin may lead to inclusion of scrotal skin when penile skin is not adequately released and mobilized.…”

Section: Discussionmentioning

confidence: 99%

“…Massive bleeding is occasionally encountered, and it requires surgical intervention [1,2]. Glans amputation [3] and urethral injury are rarer and more complicated injuries [4,5], while scrotal injuries are very rare. The hospitals and physicians in the authors' country are mandated to report circumcision complications to the Ministry of Health.…”

Section: Introductionmentioning

confidence: 99%

Scrotal injuries during neonatal circumcision

Bar-Yosef

Dekalo

Bar-Yaakov

et al. 2019

Journal of Pediatric Urology

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Glans amputation during routine neonatal circumcision: Mechanism of injury and strategy for prevention

Cited by 35 publications

References 16 publications

A Randomized Trial of Mogen Clamp Versus Plastibell for Neonatal Male Circumcision in Botswana

A Randomized Trial of Mogen Clamp Versus Plastibell for Neonatal Male Circumcision in Botswana

Examination of short and long term complications of thermocautery, plastic clamping, and surgical circumcision techniques

Scrotal injuries during neonatal circumcision

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