Circumcision Status Research Articles

A retrospective analysis of the trends in the prevalence of female genital mutilation and associated factors among women of reproductive age in Nigeria 2011-2021.

Female genital mutilation (FGM) is widely acknowledged globally as a violation of the fundamental human rights of girls and women. FGM is still widely practiced in Nigeria but at diminishing rates. Primary care physicians must educate and campaign to end this hazardous practice in Nigeria, especially in high-incidence areas. This study fills the knowledge gap by identifying FGM determinants to help policymakers reduce it. The study employed a retrospective cross-sectional design using data from the United Nations International Children's Emergency Fund for 2011, 2016-2017, and 2021. The sampling involved multistage cluster sampling. Data analysis utilized IBM-SPSS, presenting FGM prevalence across years and exploring associations with various factors. This study analyzed 63,365 Nigerian women across a decade (2011, 2016-2017, and 2021). FGM awareness fluctuated (35.1% in 2016-2017, 33.0% in 2011, and 31.9% in 2021), while FGM prevalence increased from 46.6% (2011) to 69.5% (2021). Education correlated with lower FGM prevalence. Geographic disparities were observed, with the Southwest having the highest (70.1%) and the Northeast having the lowest (34.5%) prevalence. Religion influenced FGM rates, with Christians (54.2%) and those with other/no religion (58.0%) showing higher rates than Muslims (52.6%). Urban women had a slightly lower prevalence (52.6%) than rural women (54.2%), and wealth quintiles displayed variations. Variability was also evident among states, ranging from 2.0% to 86.3%. Daughters' circumcision was influenced by maternal circumcision status, education, region, religion, and wealth quintile. Common FGM procedures involved removing genital flesh (63.7%) and nicking without removal (55.1%), often performed by nurses/midwives (63.7%). The study emphasized the urgent need for continuous awareness campaigns and education to combat FGM among Nigerian women. Education emerged as a critical factor in reducing FGM, highlighting the importance of investing in girls' education.

Parent decisional regret regarding neonatal circumcision in an American outpatient pediatric urology clinic

Requests for circumcision revision are common in our American pediatric urology clinic. As parents are the surrogate decision maker for their child, there are several influences that can impact a parent's decision for or against circumcision. We sought to assess parents' regret regarding their child's circumcision status and to correlate regret to factors that might have affected the original decision. From March 2023 to January 2024, we surveyed parents who brought their male child to our office for any reason, independent of circumcision status. The questionnaire was two-fold: a validated Decisional Regret Scale (DRS) (0-100 where higher scores=higher regret) and our questions regarding their decision-making process and outcome. Regret scores served as a function of each of the independent decision making and outcome variables. Overall, decisional regret scores from both uncircumcised and circumcised parent groups were positively skewed with a median 0, mean 22, and ranged from 0 to 75. For those circumcised (n=91), the median regret score was 0 (IQR 0-25). For those uncircumcised (n=28), median regret score was 0 (IQR 0-24). Overall, 55% of both groups reported no regret (DRS=0), 24% had low-mild regret (DRS 5-25), and 21% yielded moderate-strong regret (DRS 30-100). Parents who felt they made an informed decision or were counseled by any physician had lower regret scores. Parents who presented for issues related to their child's uncircumcised or circumcised penis (DRS score 37.5 and 25 respectively) had higher regret scores. We found that a large portion of parents expressed no regret regarding their decision to have or not have their child circumcised (55%). There also was no difference in median regret scores between parent groups. However, a significant portion of parents did express moderate-strong regret (21%) and several influential factors were correlated with regret scores. These factors included informed decision making, physician counseling, appearance satisfaction, and problems related to their child's circumcised or uncircumcised penis. These factors are supported by other literature using the DRS and population studies. The limitations of our study included the limited recruitment of participants and potential time dependent bias of responses. One in five parents of both circumcised and uncircumcised boys expressed moderate to strong regret regarding their decision about neonatal circumcision in our pediatric urology clinic. Our data suggests that ensuring parents have sufficient counseling prior to a decision regarding neonatal circumcision is important.

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

ObjectivesTo analyze current standards in urethroplasty by urologists employing buccal mucosal grafts (BMG) for treating urethral stricture disease (USD). MethodsAn IRB-approved online survey was distributed to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between July and October 2022 to assess BMG utilization in urethroplasty. Questions covered surgeon experience, graft harvest site, graft length, surgical technique, and perceived success rates. ResultsOf 350 invited GURS members, 134 responded (38%). 69% were GURS fellowship-trained, performing 10-30 urethroplasties annually. 95% harvested their own grafts, with 99% preferring buccal mucosa as the primary site. Buccal mucosa was favored over fasciocutaneous flap for penile urethroplasty, regardless of circumcision status (95% with, 84% without). For bulbar urethroplasty with BMG, dorsal graft placement was favored (66%) over ventral (34%). Most surgeons (90%) preferred multiple BMGs over combined graft/flap for panurethral strictures. When harvesting long grafts, 56% preferred using both cheeks. Anastomotic urethroplasty was preferred over buccal graft urethroplasty for short bulbomembranous stenosis post-radiotherapy (63% vs. 37%). Surgeons reported a success rate of 80-90% (53%). ConclusionsThe expanded scope of reconstructive urology has led to increased use of BMG in diverse urethral reconstructions. Buccal grafts are now preferred for penile, bulbar, and panurethral strictures, demonstrating high perceived success rates in the reconstructive community.

Understanding male circumcision: insights from a peri-urban community in Maputo City, Mozambique.

Circumcision is a protective measure against sexually transmitted infections (STIs), reducing the risk of HIV infection. This study reported coverage of male circumcision and assessed the factors associated with male uncircumcision in a peri-urban area in Maputo City, Mozambique. This cross-sectional study of the Health Demographic Surveillance System in the Polana Caniço neighborhood investigated the sociodemographic and behavioral factors associated with uncircumcised males aged 15-49 y from October 2019 to June 2021. Data were collected from an HIV risk factors questionnaire and descriptive analyses conducted comparing self-reported male circumcision status by sociodemographic factors and sexual behaviors. The association was assessed via χ2 tests, and a multivariable logistic regression model was constructed. Adjusted ORs and 95% CIs were reported for factors associated with uncircumcised status. Of the 3481 males aged 15-49 y who responded to the questionnaire, 79.5% (2766) self-reported being circumcised. The percentage of uncircumcised men steadily increased with age, ranging from 12.4% (95) among males aged 15-19 y to 34.5% (148) of men aged 40-49 y. Men without education or with primary education, as well as those not practicing Islam, were 3-4 times more likely to be uncircumcised. Uncircumcised men were more likely to self-report an STI and a lack of condom use. Being uncircumcised was associated with not using condoms and having STIs, highlighting the need to further emphasize combination HIV-prevention programs and regular HIV/STI screening. Targeting males with lower education and across religions can help reach those with lower coverage of this effective prevention intervention.

The Association between Male Circumcision and Physical Intimate Partner/Spouse Violence in Kenya

Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. Intimate partner/spouse violence is predominantly perpetrated by men against women victims. Sustainable Development Goal 5.2 aims to eliminate all forms of violence against all women and girls. This study sought to determine the association between of male circumcision and physical intimate partner/spouse violence in Kenya. Data from the nationwide and representative Kenya Demographic and Health Survey, conducted in 2014, were further analyzed. The Demographic and Health Survey utilizes a two stage stratified sampling technique. This study found that Male circumcision is very popular in Kenya (92.4%, n=12819). This study establishes that physical intimate partner/ spouse violence is rife in Kenya (34.5%, n=3265). A Pearson Chi Square test of independence found that there was a significant association between male circumcision status and physical intimate partner/spouse violence (x2(1) =44.51a, p<0.000). Binary Logistic regression predicted that the males who were uncircumcised had over two-fold higher odds of executing physical intimate partner/spouse violence compared to those were circumcised (OR 2.44, CI 1.86-3.19). This study concludes that male circumcision is beneficial in the long-term and adds to the holistic value of men beyond the physical removal of prepuce for health reasons. This study recommends male circumcision especially with a period of seclusion. This study recommends that programs should focus on initiatives or interventions that encourage male circumcision accompanied by structured learning programs during the period of initiates’ seclusion. Keywords: Male Circumcision, Intimate Partner/Spouse Violence, Social Cognitive Theory

Female genital mutilation/cutting among girls aged 0–14: evidence from the 2018 Mali Demographic and Health Survey data

BackgroundFemale genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0–14 years in Mali.MethodsWe obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs).ResultsThe results indicate that more than half (72.7%, 95% CI = 70.4–74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45–49 having the highest odds compared to those aged 15–19 (aOR = 17.68, CI = 7.91–31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27–3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91–117.00).ConclusionThe study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0–14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.

Penile dermatology for the general practitioner: A pragmatic approach to diagnosis and management.

Genital skin conditions are rare and posea diagnostic challenge due to their diverse pathology. Patient anxiety and referral decisions add complexity for primary caregivers. Demographics and overlapping symptoms complicate diagnosis, causing anxiety for both patients and clinicians. Social stigma and apprehension to seek healthcare might delay treatment. Accurate differentiation between benign and potentially serious conditions is crucial. We aim to provide clinicians with a clear and concise framework to assist them in risk stratification, treatment decisions and referral pathways for common genital skin conditions. Differentiating normal variations is crucial to minimise unnecessary investigations and alleviate patient anxiety. Circumcision status, pigmentation and genetics influence disease presentation. We highlight benign conditions for reassurance. Inflammatory genital lesions might arise from various causes. Biopsies remain essential for accurately diagnosing uncertain cases. Sexually transmitted infections (STIs) should be promptly diagnosed and treated. Neoplastic conditions can evolve rapidly, requiring an urgent specialist referral.

Female Circumcision and Sexual Negotiation Ability of Ethiopian Women.

The following study attempts to assess the link between the circumcision status of Ethiopian women and their ability to negotiate sex. From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 3,445 women aged 15 to 49. Women's sexual negotiation ability was measured by their ability to ask for condom and their ability to refuse sex. We performed a univariate, bivariate, and multiple logistic regression analysis. In the final analysis, only education, residence, media access, and sexually transmitted infections knowledge were independently associated with the sexual negotiation ability of women. Circumcision status was not associated with sexual negotiation ability.

Associations between Self-Reported Anatomical Characteristics of the Penis and Sexual Dysfunction in Men

Premature ejaculation and erectile dysfunction are common male sexual dysfunctions worldwide, causing substantial distress in men as well as their partners and decreasing the quality and stability of romantic relationships. We investigated the associations between the self-reported anatomical characteristics of penises and sexual dysfunctions in an urban sample of Chinese men. We recruited 1085 Chinese urban men aged from 18 to 50 (M = 31.37; SD = 5.52) to fill out an online questionnaire regarding the anatomical characteristics of their penis, as well as early ejaculation and erectile problems via two Chinese online survey platforms. The participants reported their age, height, weight, penile length, penile circumference, circumcision status, and foreskin characteristics as well as answered the International Index of Erectile Function-5 and Checklist for Early Ejaculation Symptoms. Both an increasing penile length (M = 14.49; SD = 2.22) and girth (M = 15.46; SD = 4.36) were associated with fewer early ejaculation problems, but only an increasing penile length was associated with fewer erectile problems. Less foreskin covering the glans of the penis was associated with fewer early ejaculation and erectile problems. Age was found to have a non-linear relationship with early ejaculation and erectile problems in this cross-sectional study. Specifically, early ejaculation problems decreased until a certain age (31), and then increased with further increases in age. The relationship between the anatomical characteristics of the penis and sexual function is complex. Also, the results suggest that there is a curvilinear non-monotonic relationship between age and sexual dysfunction.

A CROSS-SECTIONAL STUDY EVALUATING THE ASSOCIATION OF PATIENT LITERACY WITH THE STAGE OF PENILE CARCINOMA

Background: Penile carcinoma is a rare and often late-diagnosed malignancy associated with advanced-stage presentation and poor prognosis. Health literacy, the ability to understand and apply health information, is crucial in healthcare-seeking behavior and early diagnosis. Methods: This cross-sectional study, conducted over 12 months at a tertiary care center, included 150 patients diagnosed with penile carcinoma. Patient literacy was categorized into four levels based on educational background. Data on demographic and clinical variables, such as age, smoking status, circumcision status, HPV infection, and the time to medical consultation, were collected. The TNM classification system was used to determine the disease stage. Results: Lower patient literacy levels were significantly associated with an increased likelihood of advanced-stage penile carcinoma presentation (p < 0.001). Patients with limited literacy, particularly those with "No Education," exhibited longer delays in seeking medical attention, contributing to the advanced stage at diagnosis. Additional factors, such as circumcision status and the time to medical attention, were also linked to disease stage. Discussion: This study underscores the critical role of health literacy, categorized into distinct educational levels, in penile carcinoma presentation. Patients with lower literacy levels face barriers to recognizing symptoms and seeking timely medical attention, ultimately resulting in advanced-stage diagnosis. The findings highlight the need for tailored health education and awareness campaigns, especially in communities with varying educational backgrounds. Conclusion: Patient literacy is associated with advanced-stage penile carcinoma presentation. Addressing disparities in health literacy and promoting awareness of penile carcinoma symptoms may enhance early diagnosis and treatment outcomes. The study emphasizes the multifaceted nature of cancer risk factors, underlining the importance of considering cultural and healthcare-related elements in future research and public health efforts.

Factors associated with low uptake of safe male circumcision (SMC) and the intention not to undergo circumcision among men in Botswana

Abstract Aim This paper investigates factors associated with low uptake of safe male circumcision (SMC) and the intention not to circumcise among men aged 15–64 years in Botswana. Subject and methods Data were collected during the 2013 Botswana AIDS Impact Survey (BAIS IV). For analysis, a sample of 3154 men was used to assess the association between being uncircumcised/not intending to undergo circumcision and different factors using descriptive statistics and logistic regression analysis. Data analysis was conducted using SPSS version 27. Logistic regression analysis results are presented as odds ratios together with their confidence intervals. All comparisons were statistically significant at p < 0.05. Results Results show that 25.1% of men reported that they were circumcised, while 50.5% did not intend to undergo circumcision. Multivariate analysis showed that several factors were significantly associated with being uncircumcised including age of 15–24 years (OR = 2.75, CI 1.82–4.19), residing in rural areas (OR = 1.31, CI 1.09–4.1.58), and having primary or less education (OR = 2.48, CI 1.87–3.30). Similarly, factors significantly associated with not intending to be circumcised included age of 34–44 years (OR = 1.60, CI 1.15–2.23), residing in urban areas (OR = 1.27, CI 1.02–1.58), and being married (OR = 1.61, CI 1.20–2.16). It was also observed that men who had not seen or heard of SMC in the past 4 weeks were 1.2 times more likely (OR = 1.27, CI 1.03–1.56) to report the intention not to undergo circumcision. On the other hand, men who indicated that they would not circumcise their male children under 18 years of age were 8.7 times more likely (OR = 8.70, CI 6.35–11.94) to report that they did not intend to circumcise. Conclusion Results from the study show high acceptability but low uptake of SMC. Some individual behavioral factors influencing circumcision status and decision whether to undergo circumcision were identified. Targeted interventions, continuous education, and expansion of the SMC programme are recommended, especially for older men and those in rural areas.

Use of unsupervised machine learning to characterise HIV predictors in sub-Saharan Africa

IntroductionSignificant regional variations in the HIV epidemic hurt effective common interventions in sub-Saharan Africa. It is crucial to analyze HIV positivity distributions within clusters and assess the homogeneity of countries. We aim at identifying clusters of countries based on socio-behavioural predictors of HIV for screening.MethodWe used an agglomerative hierarchical, unsupervised machine learning, approach for clustering to analyse data for 146,733 male and 155,622 female respondents from 13 sub-Saharan African countries with 20 and 26 features, respectively, using Population-based HIV Impact Assessment (PHIA) data from the survey years 2015–2019. We employed agglomerative hierarchical clustering and optimal silhouette index criterion to identify clusters of countries based on the similarity of socio-behavioural characteristics. We analyse the distribution of HIV positivity with socio-behavioural predictors of HIV within each cluster.ResultsTwo principal components were obtained, with the first describing 62.3% and 70.1% and the second explaining 18.3% and 20.6% variance of the total socio-behavioural variation in females and males, respectively. Two clusters per sex were identified, and the most predictor features in both sexes were: relationship with family head, enrolled in school, circumcision status for males, delayed pregnancy, work for payment in last 12 months, Urban area indicator, known HIV status and delayed pregnancy. The HIV positivity distribution with these variables was significant within each cluster.Conclusions /findingsThe findings provide a potential use of unsupervised machine learning approaches for substantially identifying clustered countries based on the underlying socio-behavioural characteristics.

(452) Glans Necrosis is Not a Risk for Simple Inflatable Penile Prosthesis Insertion Performed via Subcoronal Incision

Abstract Introduction Some studies have questioned subcoronal incision via IPP as a risk factor for glans ischemia or necrosis. We analyzed the largest ever reported series of IPP via subcoronal incision. Objective To report complications related with subcoronal incision for IPP placement Methods We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon. 817 were first-time patients under local anesthesia, with 81 revisions under spinal anesthesia including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) in 329 (36.6%) diabetics and 38 (4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems. Results Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision (Figure-1) with all but one healing without grafting. The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%). Conclusions Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, International Medical Devices, Rigicon, Uramix.

Occurrence and Factors Associated with HIV-Sero-Discordance in Couples at Iganga General Hospital-Iganga District, Eastern Uganda

HIV sero-discordant refers to a situation where in a pair of long-term sexual partners, one is HIV positive and the other is HIV negative. There is an increased risk of HIV transmission to the HIV-negative partner in discordant couples which makes HIV serodiscordant a hindrance to HIV control and prevention strategies. Sero-discordance is one of the factors affecting the impact of HIV prevention strategies, therefore effective HIV prevention strategies must consider HIV discordance. Limited knowledge about the prevalence of HIV serodiscordant in the community hinders the formulation of appropriate strategies for effective control of HIV transmission. The study was aimed at determining the prevalence of HIV serodiscordant and its associated factors among couples attending Iganga General Hospital. The knowledge generated will guide the stakeholders in formulating HIV prevention and control strategies aimed at reducing HIV transmission. A cross-sectional hospital-based study was carried out through the conduction of guided interviews using a questionnaire to random-systematically selected 250 couples attending IGH. Data was analyzed and presented in tables with percentages comparing different factors. The HIV seroprevalence was 6.8%. The prevalence of discordance was 4.8% among participant couples and 52.2% among the infected couples. HIV serodiscordant was associated with sexual practice (83.3%), circumcision status of the male partner in the couple (58.3%), condom use (58.3%), use of ARVs by the HIV-infected partner (25%), and experience of STIs among partners (25%). The prevalence of HIV serodiscordant among the participant couples was 4.8%, associated mainly with sexual practice, circumcision, and condom use. Keywords: HIV transmission, Discordant couples, Sexual partners, Condom, Serodiscordant

Determinants of Female Genital Mutilation Among Under Five-Year Children in Motta Town, Northwest Ethiopia, 2022: Unmatched Case Control Study.

Female genital mutilation is the removal of a woman's external genitalia in whole or in part for a non-obvious medical reason. Female genital mutilation causes short- and long-term complications like bleeding, pain, infection and exposes girls to sexually transmitted diseases. The determinants of female genital mutilation among children under the age of five have received less attention. As a result, the purpose of this study was to determine the factors that influence female genital mutilation in children under the age of five. A community-based unmatched case control study design was used. The study participants were chosen using computer-generated simple random sampling technique. With a ratio of 1:4 between cases and controls, 323 participants were recruited. Data were collected using an interviewer-administered questionnaire. The association between each independent variable and the dependent variable was determined using binary logistic regression. In a multivariable analysis, variables were considered statistically significant if they had a P-value of less than 0.05 at a 95% confidence interval. In this study, mothers' circumcision status (AOR = 4.6; 95% CI: 2.29-9.25), mothers who had an unfavorable attitude (AOR = 4.15; 95% CI: 1.96-8.82), households in the poorest wealth quintile (AOR = 3.65; 95% CI: 1.2-11.54), mothers who had inadequate knowledge (AOR = 3.31; 95% CI: 1.51-7.25) and antenatal care visit of mothers (AOR = 2.46; 95% CI: 1.03-5.83) were found to be determinant factors of female genital mutilation. Mothers' circumcision status, mother's attitude, wealth quintile, knowledge of mothers, and number of antenatal care visits were factors associated with female genital mutilation. Regular awareness-building on the impacts of the practice and special attention to the mother's attitude are important to eliminate female genital mutilation.

PD37-10 THE TRUE INCIDENCE OF URINARY TRACT INFECTIONS AMONG INFANTS WITH ISOLATED HYDRONEPHROSIS

You have accessJournal of UrologyCME1 Apr 2023PD37-10 THE TRUE INCIDENCE OF URINARY TRACT INFECTIONS AMONG INFANTS WITH ISOLATED HYDRONEPHROSIS Margarita Chancy, Jin K Kim, Michael Chua, Joana Santos, Natasha Brownrigg, Juliane Richter, Tim Van Mieghem, Armando J Lorenzo, and Mandy Rickard Margarita ChancyMargarita Chancy More articles by this author , Jin K KimJin K Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Joana SantosJoana Santos More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Tim Van MieghemTim Van Mieghem More articles by this author , Armando J LorenzoArmando J Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The rate of UTI in healthy febrile infants is 7%. Isolated hydronephrosis (HN) refers to dilation of the renal pelvis and has been associated with an increased risk of UTI resulting in continuous antibiotic prophylaxis (CAP) use. Our goal was to determine the overall rate of UTI stratified by type, CAP, VUR. METHODS: A HN database from 2015-22 was examined. Included patients were less than 24 m at baseline with isolated HN, and those with other abnormalities were excluded. Captured variables included age, sex, circumcision status, HN severity and VUR. UTI was defined as fever with pyuria and positive culture from catheterized specimens. UTIs were categorized as index (pre-presentation), surveillance (while being followed), and post-procedural (associated with surgery/tests). RESULTS: A total of 689 patients were included. The median age at baseline was 2 m (0-24 m) and follow-up was 23 m (6-195). A total of 52% were prescribed CAP and received it for 6 m (0-53). The overall UTI rate was 9% which developed at 5 months (0-32 m) of age. UTIs were index in 32 (5%), surveillance in 11 (2%) and post-procedural in 20 (3%). After excluding procedural UTIs, the actual rate was 7%. Most patients were male (81%) and 62% were uncircumcised. Uncircumcised males comprised 77%, 64% and 63% of index, surveillance and post-procedural UTI respectively. 96% had isolated HN and 53% had high grade (SFU 3-4) 1% of had concomitant UPJ+UVJ obstruction and 3% were known to have VUR, however only 30% were investigated with VCUG. When comparing surveillance UTI to none, the only significant finding was more VUR in the surveillance group (18%) vs. 2% in the no infection group (p<0.01). UTI characteristics by category can be reviewed in Table 1. Comparisons between surveillance and no UTIs can be reviewed in Table 2. CONCLUSIONS: The overall incidence of UTI in children with isolated HN is low. We demonstrated that the rate of UTI is similar to the general population, generating controversy regarding the necessity of CAP. This presents an opportunity to limit exposure to antibiotics to children with isolated HN. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e991 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margarita Chancy More articles by this author Jin K Kim More articles by this author Michael Chua More articles by this author Joana Santos More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Tim Van Mieghem More articles by this author Armando J Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...

MP62-09 GLANS NECROSIS IS NOT A RISK FOR SIMPLE INFLATABLE PENILE PROSTHESIS INSERTION PERFORMED VIA SUBCORONAL INCISION

You have accessJournal of UrologyCME1 Apr 2023MP62-09 GLANS NECROSIS IS NOT A RISK FOR SIMPLE INFLATABLE PENILE PROSTHESIS INSERTION PERFORMED VIA SUBCORONAL INCISION Sung Hun Park and Steven Wilson Sung Hun ParkSung Hun Park More articles by this author and Steven WilsonSteven Wilson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some studies have questioned subcoronal incision for IPP as a risk factor for glans ischemia or necrosis.1 We analyzed the largest ever reported series of IPP via subcoronal incision. METHODS: We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon after ethical committee approval. 817 were first-time patients, with 81 revisions including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) under local anesthesia in 329(36.6%) diabetics and 38(4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems. RESULTS: Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision with all but one healing without grafting. (see below) The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%). CONCLUSIONS: Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur. Reference: 1. Wilson SK et al. Glans Necrosis Following Penile Prosthesis Implantation: Prevention and Treatment Suggestions. Urology 2017; 107:144-148. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e864 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Hun Park More articles by this author Steven Wilson More articles by this author Expand All Advertisement PDF downloadLoading ...

Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study

BackgroundIn countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini.MethodsAn observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15–21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p < 0.05.ResultsAmongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2–10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81–8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision.ConclusionIn Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.

Happiness with Circumcision Status, Not Status Itself, Predicts Genital Self-Image in a Geographically Diverse Sample.

Research exploring the impact of penile circumcision on aspects of body image is scarce and few studies have considered the potential roles of attitudinal factors toward one's own circumcision status. The purpose of the present study was to assess the potential relationship between one's circumcision status, happiness with circumcision status, genital self-image, and sexual functioning. The present study also examined how happiness with circumcision status varied across geographic regions. A total of 205 participants (102 circumcised, 103 not circumcised) completed a study through online recruitment methods. Participants reported being born in the United States (n = 80), Canada (n = 23), and various countries within Latin America (n = 22), Europe (n = 49), Asia (n = 13), Africa (n = 11), and Oceania (n = 7). Participants who were not circumcised reported significantly greater happiness with their circumcision status than participants who were circumcised. However, genital self-image, sexual body image, and sexual functioning did not significantly differ by circumcision status. Instead, participants who reported being happier with their circumcision status reported better genital self-image and less body exposure avoidance during sex, but sexual function did not differ by happiness. Although researchers hypothesized that happiness with circumcision status would depend on whether one fits in with the majority circumcision status within their region of origin, results did not support this. Participants who were circumcised tended to have less happiness with their circumcision status than non-circumcised participants regardless of region of birth. These findings support a small body of the literature which suggests that the psychosexual impact of penile circumcision may rely more on attitudinal factors toward circumcision status than actual circumcision status.

Uptake of medical male circumcision with household-based testing, and the association of traditional male circumcision and HIV infection.

Voluntary medical male circumcision (VMMC) is an important component of combination HIV prevention. Inclusion of traditionally circumcised HIV negative men in VMMC uptake campaigns may be important if traditional male circumcision is less protective against HIV acquisition than VMMC. We used data from the HIV Prevention Trials Network (HPTN) 071 (PopART) study. This cluster-randomized trial assessed the impact of a combination prevention package on population-level HIV incidence in 21 study communities in Zambia and South Africa. We evaluated uptake of VMMC, using a two-stage analysis approach and used discrete-time survival analysis to evaluate the association between the types of male circumcision and HIV incidence. A total of 10 803 HIV-negative men with self-reported circumcision status were included in this study. At baseline, 56% reported being uncircumcised, 26% traditionally circumcised and 18% were medically circumcised. During the PopART intervention, 11% of uncircumcised men reported uptake of medical male circumcision. We found no significant difference in the uptake of VMMC in communities receiving the PopART intervention package and standard of care {adj. rate ratio=1·10 [95% confidence interval (CI) 0.82, 1.50, P = 0.48]}. The rate of HIV acquisition for medically circumcised men was 70% lower than for those who were uncircumcised adjusted hazard ratio (adjHR) = 0.30 (95% CI 0.16-0.55; P < 0.0001). There was no difference in rate of HIV acquisition for traditionally circumcised men compared to those uncircumcised adjHR = 0.84 (95% CI 0.54, 1.31; P = 0.45). Household-based delivery of HIV testing followed by referral for medical male circumcision did not result in substantial VMMC uptake. Traditional circumcision is not associated with lower risk of HIV acquisition.