Implementation of an infant male circumcision programme, Pakistan

Moosa, Shazia; Muhammad, Ammar; Dogar, Sohail Asghar; Iftikhar, Sundus; Johnson, Walter D.; Latif, Asad; Samad, Lubna

doi:10.2471/blt.19.249656

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…Circumcision is common in pediatric urology [ 1 , 2 ], with a prevalence of about 7% [ 3 ]. Currently, dorsal penile nerve block anesthesia is the main anesthetic method, and circumcision under basic anesthesia is the mainstay of treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To assess the efficacy of dexmedetomidine anesthesia plus dorsal penile nerve block in pediatric circumcision. Methods. In this retrospective study, 80 children receiving circumcision in our hospital from February 2020 to February 2021 were recruited and assigned via different anesthesia methods at a ratio of 1 : 1 to receive dorsal penile nerve block plus dexmedetomidine anesthesia (combined anesthesia group) or only sevoflurane for total inhalational anesthesia (total anesthesia group). Traditional Chinese medicine (TCM) care was introduced to both groups of patients. Outcome measures included vital signs, operative indices, anesthesia effect, adverse reactions, parent satisfaction, and nursing satisfaction. Results. There were no significant differences in the heart rate, oxygen saturation, and mean arterial pressure between the two groups of children before anesthesia, after anesthesia, and during the awakening period ( P > 0.05 ). Patients receiving combined anesthesia showed a shorter time lapse before the disappearance of eyelash reflex, longer time lapse before postoperative analgesic use, faster awakening, and shorter operation time and hospital stay versus those receiving total inhalational anesthesia alone ( P > 0.05 ). The combined anesthesia resulted in a lower Induction Compliance Checklist (ICC) score, McGill score, and Richmond Agitation-Sedation Scale (RASS) score and a higher Ramsay score versus total anesthesia ( P > 0.05 ). Patients receiving combined anesthesia showed a significantly lower incidence of adverse events (5.00% (2/40)) versus total inhalational anesthesia (62.50% (25/40)) (X2 = 29.574, P > 0.05 ). The combined anesthesia group had a higher parent satisfaction (92.50% (37/40)) versus the total anesthesia group (75.00% (30/40)) (X2 = 4.501, P > 0.05 ). A total of 80 questionnaires were distributed, with a 100% return rate and a 100% validity rate, and all 80 questionnaires scored 90 points or above. The families of children in both groups were satisfied with the quality of TCM care. Conclusion. The efficacy of dorsal penile nerve block plus dexmedetomidine anesthesia in pediatric circumcision is better than total inhalational anesthesia with sevoflurane.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…They recommended circumcision to be performed on infants aged below 3 months. 19 In each community, the best timing of this procedure is defined by tradition and faith. Parental decision on neonatal or older boys’ circumcision is usually based on the parent's choice and accurate knowledge received from health workers.…”

Section: Discussionmentioning

confidence: 99%

“…A study in Pakistan showed that older children had a higher risk of complications than infants. They recommended circumcision to be performed on infants aged below 3 months 19 . In each community, the best timing of this procedure is defined by tradition and faith.…”

Section: Discussionmentioning

confidence: 99%

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

Siroosbakht

Rezakhaniha

2022

Health Science Reports

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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.

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“…Circumcision is one of the most common practices around the world, which is routinely performed to adhere to the teaching of Prophet Abraham. There is a general belief that performing such a practice does not violate human integrity nor cause any kind of moral inadequacy [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Attitude towards donation of the excised foreskin after circumcision surgery for research: A study from Madinah, Saudi Arabia

Khabour,

Mahallawi,

Ali

et al. 2023

PLoS ONE

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Studies have shown the possibility of using the part of the foreskin removed after circumcision in the field of scientific and therapeutic research. Donations of tissues and organs are always associated with ethical challenges posed by bioethicists and societies to ensure the appropriate use of these tissues/organs. The purpose of this study was to understand the attitudes and awareness of parents/guardians regarding donation of excised foreskin to research and medical use. The study was based on a questionnaire and included 133 parents/guardians who visited Uhud Children’s Hospital in Madinah, Saudi Arabia for newborn male circumcision. The results showed a high willingness (61.7%) to donate the extracted foreskin to research. The willingness to donate the extracted foreskin to research associated with undergraduate degree (P = 0.018), male sex (P = 0.011), high income (P = 0.029), and participation in previous research studies (P = 0.002). About 41.8% were convinced that written informed consent should be obtained before circumcision surgery, 38.1% (n = 51) were convinced that written informed consent should be taken after surgery, while the remaining 19.4% reported that the timing of written informed consent is unimportant. Finally, fear of excision of excess tissue (74.5%), lack of confidence in the research (68.6%), and potential for commercial use (64.7%) were the main barriers to unwillingness to donate the excised foreskin for research. In conclusion, a reasonable portion of Saudis agreed to donate their foreskin for research purposes. There is an urgent need to enhance awareness and attitudes towards tissue donation for research and therapeutic use.

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Implementation of an infant male circumcision programme, Pakistan

Cited by 7 publications

References 29 publications

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

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

Attitude towards donation of the excised foreskin after circumcision surgery for research: A study from Madinah, Saudi Arabia

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