Safe Circumcision Research Articles

Late complications following infant male circumcision using Plastibell technique: Experience from a single facility in Pakistan

BackgroundGlobally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term. MethodsThis cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review. ResultsParents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded. ConclusionThe long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.

Knowledge, Perception, and Practice of Safe Medical Circumcision on HIV Infection Risk Reduction among Undergraduate Students of a Public University in Northern Uganda: A Cross-Sectional Study.

About 70% (25.6 million) of the global HIV/AIDS burden is from Sub-Saharan Africa. Safe male circumcision (SMC) is one of the measures that were adopted by the Ugandan government aimed at reducing the risk of HIV infection contraction, as recommended by the WHO. Its main goal was to maximize HIV prevention impact with voluntary medical circumcision services to all adult men and adolescent boys. The objective of our study was to assess the knowledge, perception, and practice of safe medical circumcision on HIV infection risk reduction among undergraduate students of a public university in Northern Uganda. We conducted a cross-sectional survey among 556 randomly selected Lira University undergraduate students from March 2023 to June 2023. With the use of a self-administered questionnaire, we collected data on the knowledge and perceptions of undergraduate students towards safe medical circumcision. Data were exported to Stata® 17 statistical software. Univariate, bivariate, and multivariate regression analyses were done at a statistical level of significance P value < 0.05. Our 556 study participants had an age range of 21-25 years. The majority (81.29%) of the respondents knew that safe medical circumcision reduces the risk of acquiring HIV. However, the perception is that close to 3 in 4 (74.46%) of the students were unsure if they would opt for safe medical circumcision as risk reduction measure against HIV. The practice of safe medical circumcision was 64.8% among the study participants. More than three in four of the undergraduate students have knowledge on safe medical circumcision as risk reduction measure for HIV infection. And close to 3 in 4 (74.46%) of the student's perception were unsure if they would opt for safe medical circumcision as risk reduction measure against HIV. The practice of safe medical circumcision was 64.8% among the study participants. Therefore, in an effort to increase SMC's adoption for HIV/AIDS prevention, the Ministry of Health of Uganda and related stakeholders in health should work hand in hand with university study bodies in order to optimize SMC uptake among university students.

Strategy for the Implementation of Health Protocols on Mass Circumcision during a Pandemic in East Jakarta, Indonesia

Background: Circumcision, a religious obligation for Male Muslims in Indonesia, is conducted at a high cost using health facilities. Meanwhile, while wanting to circumcise their children the pandemic situation reduces the economic capacity of the people. Therefore, it is necessary to conduct community service activities in the form of free circumcision performed en masse to help the poor. However, due to the coronavirus pandemic which has spread rapidly since the beginning of 2020, it is necessary to adhere to health protocols. Mass circumcision during a pandemic requires a health protocol strategy to ensure that activities are performed in a safe, comfortable, and satisfying state. East Jakarta has 2,937,859 people, with 486,110 people being children of age 0-19 years. The majority of residents in this city, about 96%, are Muslims. Meanwhile 3% percent of them, or 91,610 people, are considered poor. There is still a high need for the people of East Jakarta to conduct circumcision for their children during the pandemic, even though there is a decrease in their income.&#x0D; Methods: A free, safe, and comfortable mass circumcision is required with the implementation of health protocols. Out of 170 participants registered for the circumcision, 163 of them passed the Covid-19 screening, while two did not fulfill the indications for circumcision; hence only 161 children were circumcised using the smart clamp. Furthermore, the youngest, oldest, and most circumcised participants were 1, 15, and 5 – 9 years old (60 %), respectively.&#x0D; Results: The commonly used smart clamps were 13 in numbers, and the average circumcision time for each participant was 6 minutes. Furthermore, there were mild complications among 7 participants (4%). The participants’ parents were satisfied and advised their relatives to partake in mass circumcision in the future.&#x0D; Conclusion: Meanwhile, there were no reports of participants, parents, health workers, and committee members being infected with the coronavirus after completing the activity. The health protocol implementation strategy was successfully conducted during the free mass circumcision in East Jakarta, which took place safely, comfortably, and satisfactorily.&#x0D; Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 785-796

CIRCumcision learning experience using simulation: A pilot learning platform for safe neonatal circumcision training offered either virtually or in person

BackgroundTo our knowledge, no formal training combining didactic learning, simulation, and hands-on performance is available for practitioners performing neonatal circumcision. The absence of structured training may result in avoidable complications such as bleeding and penile injury. Herein, we present the results of a pilot neonatal circumcision training platform, offered either virtually or in person.Material and methodsCIRCLES (CIRCumcision Learning Experience using Simulation) consist of 1. online didactic learning; 2. live simulation practice (in person or virtual coaching), and 3. clinical performance. Outcome measures included pre- and post-knowledge scores, self-efficacy questionnaires, and skill assessments of simulation and clinical performance (Likert rating). Face validity for training success was determined by an 80% passing score on the knowledge test and &amp;gt; 75% (mostly independent) performance.ResultsFor this pilot, we restricted enrolment to seven pediatric residents and one nurse practitioner. Wilcoxon Sum Rank test for non-parametric paired samples for pre-and post-knowledge tests showed a median increase of 20 points in post-knowledge tests (p=0.011). Upon completion of the simulation training, all participants (8/8) have chosen to perform circumcision with the GOMCO clamp. Both in-person (4/4) and virtual participants (4/4) performed &amp;gt;75% of simulation and clinical circumcision independently. Post-training self-efficacy Z scores were higher than pre-training scores, except for the management of bleeding.ConclusionThe pilot CIRCLES learning shows face validity for both in-person and virtual training for neonatal circumcision. We plan to extend this platform to include more trainees and to offer them to established practitioners. The availability of formal training may ultimately reduce adverse outcomes.

Traditional male circumcision and the risk for HIV transmission among men: a systematic review

ObjectivesTo synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on...

MP62-14 EFFICACY AND SAFETY OF TWO DISPOSABLE CIRCUMCISION SUTURE DEVICES FOR CIRCUMCISION IN ADULTS: A PROSPECTIVE COMPARATIVE MULTICENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP62-14 EFFICACY AND SAFETY OF TWO DISPOSABLE CIRCUMCISION SUTURE DEVICES FOR CIRCUMCISION IN ADULTS: A PROSPECTIVE COMPARATIVE MULTICENTER STUDY Alessia Celeste Bocchino, Esaú Fernández-Pascual, Carlos Toribio-Vázquez, Celeste Manfredi, Guillermo Urdaneta, Carlos Balmori, Andrea Cocci, Nicola Mondaini, and Juan Ignacio Martínez-Salamanca Alessia Celeste BocchinoAlessia Celeste Bocchino More articles by this author , Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Carlos Toribio-VázquezCarlos Toribio-Vázquez More articles by this author , Celeste ManfrediCeleste Manfredi More articles by this author , Guillermo UrdanetaGuillermo Urdaneta More articles by this author , Carlos BalmoriCarlos Balmori More articles by this author , Andrea CocciAndrea Cocci More articles by this author , Nicola MondainiNicola Mondaini More articles by this author , and Juan Ignacio Martínez-SalamancaJuan Ignacio Martínez-Salamanca More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Disposable circumcision suture devices have been developed to optimize outcomes of circumcision, one of the most common surgical procedures worldwide. The aim of this study is to evaluate the efficacy and safety of two different disposable circumcision suture devices (DCSDs) and compare their surgical outcomes. METHODS: A prospective comparative multicenter study was performed between November 2019 and October 2021. Patients with congenital or acquired phimosis were included. Patients underwent circumcision using a DCSD (CircCurerTM or the ZSR® device) according to the surgeon preference and device availability. Postoperative follow-up was scheduled at 1 week and 2 months for all patients. RESULTS: A total of 215 patients were enrolled, 120 underwent circumcision using CircCurerTM (Group A) and 95 patients using ZSR® (Group B). No differences were observed in baseline characteristics between the two groups (p>0.05). Mean (SD) operative time was 7.0 (2.5) minutes with no significant difference between the groups (p=0.678). Seven patients (5.8%) in Group A and 2 (2.1%) in Group B required accessory stitches (p=0.156). Four subjects (3.3%) in Group A and 1 (1.1%) in group B presented hematoma (p=0.266). Surgical site infection occurred in 1 (0.8%) in Group A and 2 (2.1%) in Group B (p=0.413). Metal clips fell out spontaneously in 39 patients (32.5%) of Group A and 47 (49.5%) of Group B (p<0.001). Median (IQR) Numeric Rating Scale (NRS) for postoperative pain was 2.5 (0-4) in Group A and 2.0 (0-4) in Group B (p=0.284). At 2 months, patients of both groups reported a median (IQR) satisfaction of 9 (8-9) points (p=0.469). CONCLUSIONS: DCSDs appear to allow effective and safe circumcision, with short operative times, uncommon and mild complications, and high patient satisfaction; although there are several devices with some relevant differences on the market. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e867 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessia Celeste Bocchino More articles by this author Esaú Fernández-Pascual More articles by this author Carlos Toribio-Vázquez More articles by this author Celeste Manfredi More articles by this author Guillermo Urdaneta More articles by this author Carlos Balmori More articles by this author Andrea Cocci More articles by this author Nicola Mondaini More articles by this author Juan Ignacio Martínez-Salamanca More articles by this author Expand All Advertisement PDF downloadLoading ...

Termokoterle yapılan sünnet sonrası gelişen fimozisin tedavisinde topikal steroid kremlerin etkinliği var mı?

OBJECTIVE: Thermocautery device is commonly used in circumcisions implemented under local an anaesthesia for a quick and safe circumcision. One of the complications that might evolve after circumcision implemented with thermocautery is pathological phimosis. Treatment of this complication is generally surgical revision. There are very few studies in the literature about it’s medical treatment. In this study, we aimed to search the efficiency of topical corticosteroid application in the the treatment of pathological phimosis evolving after circumcision implemented with thermocautery. MATERIAL and METHODS: Datas of 54 patients aged 1–9 who evolved pathological phimosis complication after circumcision in our hospital between 2011–2021 were examined retrospectively. Efficiency of topical corticosteroid application in the treatment of pathological phimosis evolving after circumcision implemented with thermocautery was evaluated. RESULTS: In 38 cases which grade 5 phimosis evolved after surgery there was no response to steroid treatment. In 6 of the 8 patients who evolved grade 4 phimosis there was no response to steroid treatment. Although there was partial response and regression to grade 3 in two patients, full recovery was not achieved and grade 4 phimosis reevolved in 2–3 weeks. 0.05% clobetasol propionate a highly strong steroid (Dermovate 0.05% 50 gr, Turkey) for 6–8 weeks morning and evening was implemented to all of the patients and circumcision revision was made in all 46 patients with no response. In 8 cases patient’s relatives did not accept topical corticosteroid and circumcision revision was made. CONCLUSION: As a result, topical steroid is not found to be effective in the treatment of phimosis evolving after circumcision implemented with thermocautery. Keywords: thermocautery, phimosis, circumcision, topical steorid, inflammation

Circumcision of Male Children in the Community Service Project: The Characteristics and Prospective Follow up Study

Background &amp; Objectives: Circumcision is a procedure that involves removing the prepuce, the fold of skin covering the head of the penis. Various medical and non-medical conditions are known indications for circumcision. Various medical benefits and complications are also known to be associated with circumcision. This study aims to provide an epidemiological characteristics of the indications and complications of circumcision. Materials and Methods: This research is a prospective follow up study conducted in the context of a community service project on November 28th-29th, 2020. Circumcision was carried out according to medical and non-medical indications. Circumcision is performed by means of the dorsumcision technique. The operators were urology residents, surgery resident, and urologists. Results: There were a total of 49 participants registered in this circumcision activity, but 5 people had not passed pre-screening conditions, so they were excluded. There were 44 participants who underwent circumcision with a mean age of 10.3 years, a BMI of 19.9 and a penis length of 5.26 cm. 14 participants (31.8%) did not experience phimosis, while the rest had phimosis to varying degrees. There were 6 participants who experienced bleeding after circumcision and 5 participants who experienced delayed wound healing at 1 week post-procedure monitoring. In the second week after the procedure, all participants experienced no symptoms of complications. Conclusion: Effective and safe circumcision is performed by medical and non-medical indications. There are no long-term complications associated with circumcision.

Troubled Custom, Custom Troubles : Initiation Challenges in the Province of the Eastern Cape, South Africa

The purpose of this article was to explore challenges facing the age-old custom of circumcision in the Eastern Cape. The paper looked into the catastrophic deaths and identify key strengths and weaknesses in the age-old custom. A qualitative approach was employed through the face-to-face interview of 10 initiated young men drawn from both urban and rural areas of the Province. The findings suggest that influences of modern male masculinity and other international actions in determining what is needed for initiation policies and practices for the Province are taken into account, along with the relevant findings from the interview component of the field research. This study concluded with a call for more research with a range of other factors to better understand how safe circumcision can be promoted in the Eastern Cape. This paper strongly suggests that initiation, as a societal matter, be treated as a matter of urgency.

Implementation of an infant male circumcision programme, Pakistan.

ObjectiveTo retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.MethodsBased on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1–92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing adverse events with infants facing no complications using multivariate logistic regression.FindingsBetween August 2016 and August 2018, 2822 circumcised male infants with mean age 22.8 days were eligible for the study. Of these, 2617 infants (92.7%) were followed up by telephone interviews of caretakers. Older infants were more likely to experience adverse events than infants circumcised between 1–30 days of age: 31–60 days: adjusted odds ratio, aOR: 2.03; 95% confidence interval, CI: 1.31–3.15; 61–92 days: aOR: 2.14; 95% CI: 1.13–4.05. Minor adverse events (100 infants; 3.8%) included failure of the bell to shed (90 infants) and minimal bleeding (10 infants). Major adverse events (eight infants; 0.3%) included bleeding that required intervention (four infants), infection (three infants) and skin tear (one infant).ConclusionStandardized training protocols and close monitoring enabled nonphysician health providers to perform safe circumcisions on infants aged three months or younger.

Is it safe to use a thermocautery device for circumcision? Examination of the histopathological changes emerging after thermocautery-assisted circumcisions.

Multiple number of techniques and devices have been described concerning circumcision method so far. One of them is thermocautery device, and it has been widely used. Although there is controversy that the penis may be damaged due to the heat generated during the use of the device, not enough histopathological studies have been conducted. We aimed to determine the histopathological changes in human foreskin caused by heat after circumcision with thermocautery and to demonstrate the safety of the use of a thermocautery-assisted circumcision. Forty-one patients were divided into two groups according to the thermal energy used during cutting with thermocautery as follows: high temperature (Group 1, n=22) and low temperature (Group 2, n=19). The effect of the heat intensity and depth of the coagulation necrosis produced with thermocautery-assisted circumcisions performed at low and high temperatures were evaluated. The difference between the groups was not statistically significant. Tissue damage is extremely limited in thermocautery-assisted circumcisions, even when it is used at high temperatures. The thermocautery device can be used for effective and safe circumcisions.

Termokoterle Yapılan Sünnet Sonrası Gelişen Fimozisin Tedavisinde Topikal Steroid Kremin Etkinliği

Objective : In our country, thermocautery device is used extensively for circumcision performed under local anesthesia for fast and safe circumcision. One of the complications that may occur after circumcision with thermocautery is pathological phimosis. However, there aren’t studies in the literature regarding the medical treatment of pathological phimosis after circumcision with thermocautery. We aimed to investigate the effectiveness of topical corticosteroid application in the treatment of pathological phimosis developed after circumcision with thermocautery. Material&Methods: Data of 68 patients (aged: 1-8 years) who developed phimosis secondary to circumcisions performed by one surgeon between the years 2009 and 2018 were analysed retrospectively from a computerised database. Cases of phimosis developed after circumcisions performed using thermocautery and scalpel were analysed in two separate groups, and the effectiveness of topical steroid treatment was evaluated. Results : In the thermocautery group, 32 patients who developed Grade 5 phimosis didn’t respond to steroid therapy, while only three of 16 (18.75%) cases with Grade 4 phimosis responded partially to topical steroid treatment. All these 48 cases were treated with surgery. In the scalpel group, no therapeutic response was elicited in four cases who developed Grade 5 phimosis. However, four out of eight (50%) patients with Grade 4 and six out of eight (75%) patients with Grade 3 phimosis responded to steroid therapy, and full retraction of the foreskin was achieved. In the scalpel group, ten cases underwent surgical revision. Conclusion : Topical steroid creams may be partially beneficial in cases of pathological phimosis after circumcision. However, they do not show efficacy in cases of high-grade phimosis after thermocautery use.

Thermal cautery-assisted circumcision and principles of its use to decrease complication rates

Circumcision is one of the most frequently applied surgical procedures all over the worldand a number of techniquesand devices have been described concerning its method. Especially in developing countries where circumcision has been performed intensively under local anaesthesia, the thermocautery device developed to perform circumcisions in a short timeand safely has found a widespread application. We aim to share our experiences concerning application principles of the thermocautery device so as to be able to achieve better cosmetic results with lower complication rates. Between the years 2009 and 2016, a total of 12,355 children between the ages of 40 days and 16 years (mean: 5.1±2.0 years) were circumcised at our hospital. All circumcisions were performed by urologists under local anaesthesia using a thermocautery device (Thermo-Med TM 802B device; Thermo Medikal, Adana, Turkey). Bleeding that required surgical intervention did not occur in any patient. Compressive dressing was applied to 62 patients who had moderate degrees of bleeding, for haemostasis purposes. Twelve syncopes and four epileptic seizures developed secondary to local anaesthesia were managed in consultation with the Department of ChildrenHealth and Diseases. The most serious complication, trapped penis, was seen in 48 patients. All these complications were resolved using surgical interventions. Infection developed in 15 patients, and it was relieved with the administration of oral antibiotherapy. Penile adhesions were relieved in 25 cases, and anti-inflammatory treatment was organised. Meatal stenosis occurred in three cases, and two cases of inclusion cysts were treated with surgical intervention. In countries where circumcision is routinely applied, developing swift and safer methods are of the utmost importance. To this end, we prefer thermocautery, which can satisfy patient demands swiftly and safely. To reduce the complications after circumcision using thermocautery, we think that it is appropriate to pay attention to the following issues during circumcision: The cautery should be turned in a serial manner and both sides of the blade should be used for cutting, and temperature of the thermocauter should be adjusted according to the skin thickness. The cutting process should be achieved in two steps, and another method should be preferred for buried penis. If these rules are followed, we think that the thermocautery-supported method can be a very safe and fast circumcision method.

Correlates of Men’s Willingness to Undergo Safe Circumcision in the Era of the HIV/AIDS in Botswana

Correlates of Men’s Willingness to Undergo Safe Circumcision in the Era of the HIV/AIDS in Botswana

Circumcision in patients with bleeding disorders: Can it be done safely?

Purpose: The purpose of our study was to review outcome of circumcision among children with bleeding disorders at our institution and also to determine the impact of optimization leading to safe circumcision. Methods: Data representing boys (age 0-16 years) who underwent routine circumcision at the Aga Khan University Hospital (AKUH) between1988-2014 was retrospectively reviewed. Children with bleeding disorder were identified using International Classification of Diseases (ICD) Code 64.0. Data was retrieved and confidentially was maintained. SPSS version 19 was used for statistical analysis. Results: During 26 years 13,200 circumcisions were performed at AKUH. Amongst these 8,463 (64.11%) were done by using Plastibell, while 4,737 (35.88%) by open slit method. Only 23 (0.17%) children were identified with bleeding disorder. Two groups were made, Group-A (n:15) children with known bleeding disorders having circumcision and GroupB, (n:8) those in whom bleeding disorder was diagnosed after circumcision. Median age of children in Group-A was 9 years. All children in Group-A underwent open circumcision. 10 patients had Factor VIII deficiency, 2 had Glanzmann’s thrombasthenia, 1 had Factor IX deficiency, 1 had Quebec platelet disorder, and 1 had Von Willebrand disorder. Median age of children in Group-B was 3 months. 7 out of 8 underwent plastibell while one had circumcision by open technique. 7 were diagnosed as Factor VIII deficiency and 1 diagnosed later to have Glanzmann's thrombasthenia. Statistical analysis showed significant difference among these two groups’ p-value with respect to age (p-value 0.00) and family history (p-value 0.04- Fisher’s exact test). Both groups had similar postoperative length of stay. Overall bleeding complication rate after optimization was 13.33%. Conclusion: With the help of hematologist and adequate Factor replacement, these children can be managed as daycare. We suggest risks and benefit should be discussed with parents before procedure

Sutureless, bloodless, safe new circumcision technique

Background: Several techniques of circumcision are available such as conventional surgical technique, the device (Gomco, Plastibell), mono and bipolar diathermy and sutureless methods such as fibrin glue. Our knowledge, the first report of using harmonic scalpel in circumcision was published by Peng et al, in the Asian journal of andrology but the study was done on dogs, this one of the little studies describe the use of the harmonic scalpel in male circumcision in humans. Aim was to describe the technique of the harmonic scalpel circumcision and report its outcomes in the term of safety and efficacy.Methods: This was a prospective observational study performed in the general surgery department at Sohag university hospital, Sohag, Egypt from 1st January 2015 to 31 December 2016.Results: 90 male patients were included in this study. Their age ranged between 3 and 18 years. The most common indication was religious circumcision 50%. No intraoperative blood loss or a postoperative bleeding. One case of wound infection and three cases of a postoperative edema respond to conservative treatment. No injury to the surrounding structure.Conclusions: The result of this study determines that the harmonic scalpel circumcision not associated with intraoperative blood loss or postoperative bleeding and a good postoperative cosmetic result, with a minimal complication. So, it is an appropriate alternative to the traditional scalp and suture technique.

Reported Male Circumcision Practices in a Muslim-Majority Setting.

Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child's circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20–25 million boys worldwide.

P18.03 Rapid training and implementation of the pollock technique, a safe, rapid and effective newborn circumcision procedure, in a low-resource setting

Background Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to re-introduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti—an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate—after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. Methods The rapid, newborn circumcision training program was conducted in November 2014 at the GHESKIO Health Centres, a large, non-governmental clinic offering comprehensive paediatric and adult health services. Two Haitian obstetricians and seven nurses learned administrative, educational, and clinical newborn male circumcision procedures. Complications were monitored and surveys were given to the obstetricians, nurses, and parents of the newborns for assessment. Results Upon training completion, one of two obstetricians achieved procedural competence. The team circumcised 92 newborns with minor bleeding observed in 1 infant; there were 0 moderate or severe complications. Obstetricians, nurses, and parents of the newborns reported that they were very satisfied with the program (100%, 92%, and 94%, respectively). Of the parents, 100% reported they would recommend the procedure to their friends and 100% reported that they were satisfied with the cosmetic result of the procedure. The nurse-collected survey indicated that 100% of the procedures followed the proper protocol. Since the rapid newborn circumcision training program concluded, the GHESKIO Health Centres have dedicated two days a week to perform newborn male circumcisions, averaging 14 patients per week Conclusion Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions. Funding UCLA Centre for AIDS Research (CFAR) NIH/NIAID AI028697, NIH/NICHD R21HD076685, Pollock Foundation, and Klausner Research and Education Fund.

Penile Injuries In Lagos State University Teaching Hospital Ikeja: A 7-year Experience

Background : Injuries to the penis are not frequent events and usually not life threatening. However, they may be associated with significant long term psychological and functional impairment. This study elucidates the clinical spectrum of penile injuries in the Lagos State University Teaching Hospital and how they were managed. Methods: This was a 7-year retzrospective study of all cases of penile injury managed in the Urology unit of a teaching hospital in South West Nigeria; between February 2006 and January 2012. Results : There were 50 cases of penile injury, with the age range between 4 weeks to 49 years and an average age of 12.1 years. Circumcision and sex-related causes accounted for 76% and 18% of the injuries respectively, while occupation and ritual-related causes accounted for 2% each. Urethro-cutaneous fistula (n=22, 44%), penile fracture (n=9, 18%) and penile amputation (n=5,10%) were the commonest injury types. All the cases were managed operatively. Coculusion: Circumcision was the leading cause of penile injury in this study. Mass education of all categories of circumcisers on safe circumcision practices would be desirable.

Medically assisted circumcision: a safer option for initiation rites.

[Extract] Culturally sensitive integration of medical circumcision could avert adverse effects at traditional male initiation rites. In many traditional cultures, male initiation rites involve circumcision practices that can sometimes result in medical complications. In a recent incident in the Northern Territory, three young men required airlifting from their Borroloola initiation site to Darwin for medical assistance. The risk of permanent harm and potentially fatal outcomes could be decreased if safer options were available during initiation ceremonies. In this article, we report that it is possible to provide safe circumcision at male initiation rites.