Unexpected Complications Following Adult Medical Male Circumcision Using the PrePex Device

Abstract

Introduction: In this study, we describe and depict unexpected sequelae of adult medical male circumcision (MMC) using the PrePex device. Materials and Methods: The PrePex system is an elastic compression device for adult MMC. The device is well studied, has been pre-qualified by the World Health Organization (WHO), and its use is being scaled-up in African countries targeted by WHO. We conducted a PrePex implementation study in routine service delivery among 427 men in the age range of 18-49 in western Kenya. We captured penile photographs to create a record of adverse events (AEs) and to monitor healing. Several unexpected AEs ensued, including some that have not been reported in other PrePex studies. We describe and depict those unexpected complications and resulting treatments to alert circumcision providers in the relevant areas. Results: We observed 5 device displacements (1.2%); 3 cases of early sloughing of foreskin tissue (0.7%) among men with long foreskins; 2 cases of a long foreskin obstructing urine flow, as it became dry and necrotic (0.5%); and 2 cases of insufficient foreskin removal caused by invagination for which surgical completion was necessary (0.5%). All of the participants healed completely by day 42 post-circumcision or shortly thereafter. Conclusion: The potential for these complications should be incorporated into PrePex training programs. Integration of devices into MMC programs in medically underserved areas requires the availability of prompt surgical intervention for some sequelae, particularly displacement events.

Systematic review of complications arising from male circumcision

“…Unexpected complications following adult medical male circumcision using the PrePex Device 83 29. Long foreskin obstructing urine flow Unexpected complications following adult medical male circumcision using the PrePex Device 83 30.…”

“…Unexpected complications following adult medical male circumcision using the PrePex Device 83 29. Long foreskin obstructing urine flow Unexpected complications following adult medical male circumcision using the PrePex Device 83 30. Insufficient foreskin removal/redundant foreskin Unexpected complications following adult medical male circumcision using the PrePex Device 83 Acute ischemia of the glans penis after circumcision treated with hyperbaric therapy and pentoxifylline: Case report and revision of the literature 25 Complications of circumcision 27 Revisions after unsatisfactory adult circumcisions 60 Buried and trapped penis: A case report 75 Circumcision mishaps in Nigerian children 20 Rates of complications after newborn circumcision in a well-baby nursery, special care nursery, and neonatal intensive care unit 29 Circumcision-related tragedies seen in children at the Komfo Anokye Teaching Hospital, Kumasi, Ghana 38 Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure 32 (Continues)…”

Differentials in Male Circumcision Prevalence, HIV/AIDS Knowledge and Behavioral Prevention Practices Among Men in Nigeria

“…These studies also help to explain the notable geographical variations in the prevalence of HIV infection within sub-Saharan Africa. The increasing focus on circumcision practices is also driven by empirical evidence suggesting a lower incidence of certain sexually transmitted infections (STIs) and HIV among circumcised individuals [14,16,17]. Some research even suggests that circumcision could reduce the HIV infection rate by up to 70%, marking a significant contribution to public health [18,19].…”

Medical Male Circumcision and HIV Testing Practices among Men Aged 15 to 59 Years Old: Evidence from Zambia Demographics and Health Survey

“…Others allude to the religious, cultural health, and historical dimensions of the MMC and have ensured its practice is preserved [4]. Given the empirical evidence that suggests a lower rate of certain sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) in individuals that are circumcised, there has been increased attention to MMC practices [5,6]. Some studies suggest that MMC is highly beneficial compared to the potential risks considering that it could lower up to 70% of the HIV infection rate which is a new phenomenon [7].…”