Abstract
BackgroundThe past four years has seen a rapid roll-out of male medical circumcision services in South Africa in response to clinical trials showing circumcision prevents HIV acquisition in heterosexual men. Clinics conduct substantial numbers of circumcisions per day. We report three cases of glans amputation in adolescents attending high volume clinics where modified Models of Optimising Volume and Efficiency (MOVE) are implemented.Case presentationsThree cases of glans amputation in young healthy men that presented for voluntary medical male circumcision. The procedures were performed by highly experienced medical officers in two cases. All these cases shared characteristics: younger males with immature genitalia, forceps guided circumcision, and likely operator fatigue. Voluntary male medical circumcision programs should include regular monitoring and evaluation and training of operators to ensure high quality surgical techniques such as working in clean areas and taking frequent breaks.ConclusionCircumcision is a relatively simple medical procedure, however regular training and quality control in high volume Male Medical Circumcision sites is essential to prevent rare catastrophic adverse events.
Highlights
The past four years has seen a rapid roll-out of male medical circumcision services in South Africa in response to clinical trials showing circumcision prevents Human Immunodeficiency Virus (HIV) acquisition in heterosexual men
To date approximately 2,84 million circumcisions have been conducted at multiple high-volume Voluntary Medical Male Circumcision (VMMC) clinics across the country [5]
Since the roll-out began, moderate adverse events have been reported occurring in fewer than 2% of patients circumcised [5, 6]. It is important for the management of male circumcision programs both in South Africa and elsewhere that adverse events be reported as there are rare instances of severe complications, which should be monitored and responded to, thereby preventing future events [7]
Summary
The past four years has seen a rapid roll-out of male medical circumcision services in South Africa in response to clinical trials showing circumcision prevents HIV acquisition in heterosexual men. As part of quality control, we reviewed three glans amputations that occurred at these high volume VMMC clinics and report them as a case series. On the day of the event, at total of 97 circumcisions were performed at the clinic, 22 of these by the operator involved in the glans amputation prior to the incident.
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