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

BMC Urology

Table 3 Prospective studies of frequency of complications in studies of child circumcision undertaken by medical providers

Author	Country	Years	Setting	N	Age	Provider	Method	Indication	Follow-up period	Frequency of adverse events^a	Frequency of serious adverse events^b
Ahmed [43, 59]	Comoros Islands	1997-1998	Home	3824	2-8 years	Surgical aids, nurses & midwifes	Dorsal slit	Routine	11 days	2.3%	0.5%
Aldemir [48]	Turkey	2006	Hospital	200	2-9 years	Urologist	65% Smart clamp 35% Dissection	Routine	6 weeks	5%	1%
Bazmamoun [45]	Iran	2006-2007	Hospital	394	Mean 9 months	Surgeon	Sleeve	Routine	6 months	7-10%^c	0%
Griffiths [49]	England	1985	Hospital	99	Mean 4.3 years	-	Dissection	85% medical 11% religious 4% other	3-5 weeks	6.4%^d	2.8%^e
Ozdemir [46]	Turkey	1990s	Mass circ. in hospital	700	8 days to puberty	-	Forceps guided	Routine	3 months	8%^f	0%
Schmitz [51]	Holland	1997	Health centre	94	Median 3 years	GP residents under supervision of a surgeon	Freehand	Religious	1 week	12%	0%
Schmitz [50]	Malaysia	2001	Community	64	Median 10 years	Medical assistants supervised by doctors	TaraKlamp	Routine	6 weeks	1.6%	0%
Sharma [44]	India	2003	Hospital	15	2-25 years	Surgeons	Dorsal slit	Medical or religious	90 days	13.3%	0%
Sorensen [52]	Denmark	1981-1983	Hospital	43	Mean 6.5 years (range 1-13)	Surgeon (early stage in training)	Plastibell	Medical	Mean 29 months	Immediate postoperative (reported) 9.3%^g Late complications (reported) 0%^h	0%
Subramaniam [47]	Singapore	-	Hospital	152	Mean 7 years	Surgeon	CO₂ laser	Not given	-	4.6%	0.7%

^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 13 boys had meatal stenosis and 26 had infection. It is not clear whether there is overlap between these two groups.
^d Defined by the authors as any admission to hospital or further surgery.
^e Acute re-admissions to hospital
^f Includes 15 cases of inadequate circumcision, since these were accompanied by secondary phimosis
^g One case of haemorrhage that stopped spontanesouly, 2 cases of erythema and pus with no confirmed infection or antibiotic treatment and 24 cases of dysuria due to irritation of the meatus due to the presences of a Plastibell excluded
^h Seven cases of slight irritation of the glans excluded

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