Complications of circumcision in male neonates, infants and children: a systematic review

Weiss, Helen A; Larke, Natasha; Halperin, Daniel; Schenker, Inon

doi:10.1186/1471-2490-10-2

BMC Urology

Table 1 Prospective studies of frequency of complications in studies of neonatal and infant circumcision

From: Complications of circumcision in male neonates, infants and children: a systematic review

Author	Country	No. of patients	Age	Type of provider	Method	Follow-up period	Frequency of adverse events^a	Frequency of serious adverse events^b
Al Samarrai [11]	Saudi Arabia	2000	2-3 days	Junior staff with supervision	Plastibell	6 weeks plus immunisation clinic visits	1.4%^c	0%
Amir^d [21]	Saudi Arabia	1000	Mean 9 days	Surgeon	Gomco clamp	1 year	1.6%	0%
Banieghbal[32]	South Africa	583	Neonatal	Surgeon	Gomco clamp	1 month	0.3%	0%
Ben Chaim [9]	Israel	19,478	Mean 8 days	83% Mohel 17% Physician	Freehand	-	0.1%	0.1%
Bhat [22]	Oman	250	Neonatal (min 1 day)	Paediatrician	Plastibell	-	0%	0%
Duncan [23]	Jamaica	205	Neonatal	Surgeon	Plastibell	1 week	1.5%	0%
Horowitz [24]	USA	130	98 neonatal 32 infants (3-8.5 months)	Pediatric urologist	Gomco clamp	3 days	Overall: 7.4% Neonatal: 0% Infants: 30%	0%
Manji [25]	Tanzania	368	7 days to 9 months	Pediatrician	Plastibell	-	2.8%^e	0%
Mousavi [33]	Iran	586	<12 months	Surgeon	50% sleeve 50% Plastibell	-	Sleeve: 1.95% Plastibell: 3.1%^f	Sleeve: 0% Plastibell 2.1%
Okafor [26]	Nigeria	102	Immediate post-partum	Experienced surgeon	Plastibell	1 year	0%	0%
Okeke^g [10]	Nigeria	322	8 days-13 months	55% Nurses 35% Doctors 9% Trad.	-	3 month	9.3%	1.0%
Osuigwe [27]	Nigeria	141	7-9 days	54% Doctors 44% Midwives 2% Trad. birth attendants	68% Plastibell 31% freehand	6 weeks	13.5% Plastibell: 8% Freehand: 27.3%	2.1%
Palit [28]	UK	1129	Mean age 11 weeks	Trained nurses under supervision of consultant urologists	Plastibell	3 months	5.5%	0.1%
Patel^d [29]	Canada	100	3-5 days old	98% Medical doctors 2% Traditional Providers	51% Gomco 47% Plastibell 2% Ritual	-	15%^h	2%
Perlmutter [30]	USA	51	Neonatal	Obstetrician or resident	Gomco	Up to 2 hours	0%	0%
Rehman [31]	Pakistan	200	Infant	Surgeon	50% freehand 50% bonecutter	1 week	16%	0.5%

^a Cases of minor bleeding stopped with simple pressure or 'conservative management' and excessive foreskin/inadequate circumcision are not included
^b Includes complications defined as 'serious' or 'severe' by authors, or with long-term or life-threatening sequalae (partial amputation of glans, urethral laceration, need for re-surgery or plastic surgery)
^c 18 patients with yellowish patches of sloughed tissue and erythema who did not have an infection confirmed through cultures, 4 patients with irregular skin margin and 4 patients with inadequate skin excision were excluded
^d In these studies patients who had undergone circumcision were identified retrospectively, but wherever possible patients were actively followed up to obtain accurate complication risks.
^e Risks by age at circumcision: 7-14 days: 0.9%; 15 days - 2 months: 4.7%; 2 - 9 months: 11.5%
^f Excludes 'excess mucosa' and 'delayed Plastibell falling off'
^g Patients were identified through an immunization clinic and a physical examination was conducted to confirm circumcision status and the presence and type of complications. Uncircumcised boys were followed up to identify boys circumcised at a later age and any complications
^h 31 cases of mild oozing, 7 cases of mild infection with no antibiotic treatment were excluded

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ISSN: 1471-2490

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