Parental Perspectives Regarding Circumcision during the Coronavirus Disease 2019 Pandemic in Indonesia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has rapidly spread worldwide and affected the healthcare system, including the deferral of surgical practice. There are various reactions regarding delayed surgeries, but parental viewpoints towards circumcision remain scarce. In light of the pandemic, this study aimed to evaluate how parents feel about circumcision and the probable determining variables. MATERIALS AND METHODS: This study is a cross-sectional study based on an online questionnaire available from March to April 2022. The factors affecting the decision were analysed using logistic regression. RESULTS: Of 1,218 (26.28%) parents who completed the survey, 879 (18.96%) met the inclusion criteria and were included in this study. Among them, 615 (70.00%) parents agreed to delay circumcision during the COVID-19 pandemic. These respondents were more likely to be non-Muslim (P = 0.01), have no relatives whose work is related to medicine or paramedicine (P = 0.02) and have monthly income equal to or below the regional minimum wage (P = 0.03). After adjusting the potential confounder, non-Muslim religion (odds ratios, 2.87; 95% confidence interval, 1.27-6.49; P = 0.012) was found to be the only independent predictor for agreeing to the deferral of circumcision amid the pandemic. CONCLUSION: Most parents agreed to postpone circumcision due to the fear of COVID-19 exposure. In order to help them feel less apprehensive about this matter, it is important to educate them about the medical benefits of circumcision and the safety of this procedure.

Successful Management of Recurrent High-Flow Priapism Treated with Selective Arterial Embolization: A Case Report.

Introduction: High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism, i.e., conservative management, the use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report the use of Gelfoam and microcoil embolization in recurrent high-flow priapism compared to PVA embolization. Case Study: A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patient's groin hitting a rocky ground. Physical examination revealed an erect penis, which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with a pH of 7.47, pCO2 of 23.6, pO2 of 145, HCO3 of 17.3, BE of -6, and SaO2 of 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed, and there were decreased complaints. A few hours later, the erection occurred. Reevaluation was then performed and continued with embolization using Gelfoam and microcoil. There were immediate successful results (EHS of 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury. Conclusion: Priapism may happen due to various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.