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

BMC Urology

Table 4 Retrospective studies of frequency of complications in studies of child circumcision undertaken by medical providers

Author	Country	Years	Setting	N	Age	Method used	Indication	Frequency of adverse events^a	Frequency of serious adverse events^b
Ahmed [7]	Nigeria	1981-1995	Hospital	1563	Mean 4 years	-	Routine	0.3%	-
Atikeler [54]	Turkey	1999-2002	Hospital	782	Mean 6 years	-	Medical indication or religious reasons	2.6%	0%
Cathcart [74]	UK	1997-2004	Hospital	66519	0-15 years	-	98% Medical	1.2%	0%
Lazarus [53]	South Africa	1999-2005	Hospital	95	'boys'	-	Medical or religious	5.1%	2.5%
Leitch [69]	Australia	1960s	Hospital	200	Mean 2 years	-	71% Medical 29% Cultural	11%	0%
Millar [75]	South Africa	1985-1987	Hospital	129	3 months to 10 years	Plastibell	19 revisions	12%	-
Ozdemir [46]	Turkey	1990s	Hospital	600	8 days to puberty	Forceps guided?	Routine	1.7%	0%
Peng [76]	China	2005-2007	Hospital	160	5-12 years	Shenghu disposable device	Mainly medical	Complications whilst wearing device : 17.5%^c Complications after removal of device : 0.6%	0.6%
Rizvi [64]	Pakistan	1981-1991	Hospital	3096	'children'	-	-	1.6%	-
Wiswell [18]	USA	1985-1992	Hospital	476	Mean 3 years	Freehand or sleeve	Cultural (67%) Medical (33%)	1.7%	0.2%
Yegane [77]	Iran	2002	Community	1766	71% after 2 years of age	-	-	4.6% overall (late complications) 2.8% Urologists/surgeons 6.1% GPs/pediatricians 9.1% Paramedics	0%

^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 Seventy cases of swelling pain from nocturnal erection excluded

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