Complications of circumcision
Nerve Sparing Esthetic Circumcision
Complications are seen in two-ten percent of all circumcision operation. This percentage increases in the operations performed by unskilled persons.
The mostly seen complications:
Bleeding and hemorrhage are the most common urgent risks of circumcision. It occurs due to loosely tightened or missed vessels in which circumcision performed uncautiously.
Bleeding is usually controlled with pressure applied to the affected area until the bleeding stops. Small amount of blood leaking is not so important. If a big patch of blood in the diaper following circumcision, you can call the doctor. Diapers can absorb a lot of blood without it being noticeable. Sometimes, bleeding cannot be controlled so that it may require to contact the doctor or take your child to emergency care immediately.
Bleeding may be due to bleeding disorders. Especially if a circumcision is planned for a newborn, a vitamin K injection must be done just after birth to prevent bleeding problems due to clotting disorders.
A swelling under the penil skin caused by bleeding and clotting.
İnfection, bacterial or some agents of serious diseases such as Hepatitis B and Hepatitis C are seen very frequently in circumcision performed by using non-sterile surgical devices in the non-hygienic medium.
It is important to keep the area clean for 7 to 10 days following circumcision. Parents must consult the doctor immediately if any signs of fever, inflammation, discoloration, or infection are seen.
Pain can range from moderate to severe, and may continue for 7 to 10 days post circumcision or until the surgical site is fully healed.
- Edema (swelling of tissue):
Bulla formation and edema in penil skin after circumcision.
- Encrustation and of glans penis:
It is because of erosions on the glans penis while prepucium is seperated from it or drying of glans mucosa after circumcision. It usually lasts 7-10 days after operation.
- Irritation of glans penis:
It is caused from revealing of glans penis which is quite tender after circumcision. It resolves in a few days.
- Meatitis: It is an inflammation of urethral meatus (external opening). It is usually caused by the irritative effects of ointments or antiseptic solutions conaining iodine.
- Cosmetic/functional damage to the penis:
Up to 10% of infants require a circumcision revision to correct uneven, unsatisfactory, or other poor results. The number of circumcision revision surgeries varies by region, but appears to have no bearing upon the skill, experience, or chosen method of the circumciser.
Cosmetic/functional damage can include skin bridges, adhesions, buried penis, damage to the glans, damage to the urethra, damage to the underlying erectile tissue, or other complications.
There are no official training programs for circumcisers in North America, and there are no official standards regulating the procedure.8
A complication because of excessive skin removal after performing a circumcision by using Smart clamp (plastibell) technique. A ring-shaped, brownish area under glans represents necrosis in penile and scrotal skin.
- Urethral fistula: Urethral injury seems more likely to occur when there is bleeding from the frenulum and an attempt is made to control it with a suture. A suture placed too deeply may strangulate a part of the urethral wall, thus leading to the formation of a fistula. Sometimes an unintended incision or puncture on urethra is the reason.
- Complete or incomplete cutting of glans penis, damage to erectil tissue of penis
- Heavy bleeding necessitating urgent intervention: Bledding may be profuse which may lead to shock or even death unless noticed.
- Severe infection
- Meatal Stenosis:
Approximately 10% of all circumcised boys will develop this complication. The loss of blood flow to urethral meatus or constant rubbing against diapers can scar and narrow the meatus, making urination more painful or difficult. In serious cases it can cause retention of urine besides urgent medical problems with the bladder, kidneys. Meatal stenosis is often diagnosed when the circumcised child presents to a physician with a urinary tract infection (UTI).
An asymmetry and opening between wound edges after circumcision by using smartclamp technique.
The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair.
Skin bands (bridge) and strictures between suture line and glans penis which is traumatized during dissection of prepucium.
Because of cutting the prepucium with cautery or breaking off the wound sutures, the incision lines may seperate. Inappropriate healing may increases scarry tissue and cause to a bad appearance.
- Incomplete excision of prepucium: A part of glans penis is buried in retained prepucium. A second operation is needed to remove the remaining prepucial skin.
- Allergic reactions (anaphylaxis) against to aneshetic substances:
The high dose use of aneshetic substances such as lidocaine or prilocaine may cause a seriouscondition called methemoglobinemia. In case of giving these substances parenterally may lead to cardiomyopathy.
- Reduced intensity of sexual pleasure and orgasm:
Although this subject is one of the most serious complications of traditional circumcision, it is not taken into consideration. Erogeneous senses lessens due to cutting of superficial nerves and nerve corpuscles.
- Psychological disturbances:
These conditions are usually appear in anxietic or frightened children that are circumcised in the phallic period (3-6 years) and even expose to violence. An extreme anger or lessening sense of trust against to their parents may develop in the children.
- J. Shulman, MD; N. Ben-Hur, MD; Z. Neuman, MD. Surgical Complications of Circumcision. Am J Dis Child. 1964; 107(2): 149-154. http://archpedi.jamanetwork.com/article.aspx?articleid=500844
- N. Williams and L. Kapila. Complications of circumcision. British Journal of Surgery, Volume 80, 1231-1236,October 1993. http://www.ncbi.nlm.nih.gov/pubmed/8242285
- Aaron J. Krill, Lane S. Palmer, and Jeffrey S. Palmer. Complications of Circumcision. Scientific World Journal. 2011; 11: 2458–2468. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253617/
- Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox and Robert S. Van Howe. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007 Apr;99(4):864-9.http://www.ncbi.nlm.nih.gov/pubmed/17378847
- Dan Bollinger. Lost Boys: An estimate of U.S. circumcision-related infant deaths. Thymos: Journal of Boyhood Studies, vol. 4, No. 1, Spring 2010, 78-90. http://www.academia.edu/6394940/Lost_Boys_An_Estimate_of_U.S._Circumcision-RelatedInfantDeaths
- Carlos A Angel, MD. Meatal Stenosis. eMedicine June 12, 2006 http://emedicine.medscape.com/article/1016016-overview
Hakan ERDOGAN, M.D
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