Outcome of circumcision for newborns with penoscrotal web: oblique skin incision followed by penis shaft skin physical therapy shows success.

SHORT INTRODUCTION/BACKGROUND: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. OBJECTIVE: With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. STUDY DESIGN: Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the 'normal' group if they had no penile anomalies or the 'web' group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as 'push down' the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. RESULTS: Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. DISCUSSION: It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. CONCLUSION: It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.

Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world's first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.

[Penile frenulum lengthening for premature ejaculation].

OBJECTIVE: To evaluate the effect of penile frenulum lengthening in the treatment of premature ejaculation (PE). METHODS: Thirty-four males with PE were enrolled in this study, of whom 8 had received circumcision six months before and 4 had redundant prepuce, all with short frenulum. Those with a history of circumcision underwent reconstruction and lengthening of the frenulum, and those without received frenulum lengthening only. RESULTS: Compared with the baseline, the intravaginal ejaculation latency time (IELT) was significantly increased at 1 month after operation ([1.35 ± 0.49] vs [5.71 ± 2.69] min, t = -9.42, P <0.01), (1.42 ± 0.5) vs (5.31 ± 2.74) min in the patients without circumcision (t = -7.41, P <0.01), (1.12 ± 0.35) vs (7.00 ± 2.20) min in those with circumcision (t = -7.24, P <0.01), and (1.50 ± 0.58) vs (4.75 ± 1.71) min in those with redundant prepuce (t = -3.81, P <0.05). Totally, 94% of the patients were satisfied with their sexual intercourse postoperatively. CONCLUSION: Penile frenulum plays an important role in penile erection. Reconstruction and/or lengthening of the frenulum can prolong penile erection and IELT in PE patients.

Complications of neonatal circumcision requiring surgical intervention in a developing country.

OBJECTIVE: The recent scale-up in neonatal circumcision (NC) may require strategies to reduce complications. This study evaluated complications of NC requiring surgery. METHODS: A prospective analysis of 64 patients with complications of NC managed by surgery between June 2006 and May 2012 at the University of Nigeria Teaching hospital Enugu was conducted. RESULTS: Circumcision was performed by nurse in 54 (84.4%) patients, traditional practitioner in 5 (7.8%) and doctor in 5 (7.8%), at a median age of 9 days (range: 2-21 days). Complications noticed 1 day to 7 years (mean: 7.8 months) after circumcision were glanular adhesion in 27 (42.2%) children, meatal stenosis in 14 (21.9%), urethrocutaneous fistula in 11 (17.2%), trapped penis in 5 (7.8%), implantation dermoid in 4 (6.2%) and glans amputation in 3 (4.7%). After treatment, outcome was good in 59 (92.2%) patients, whereas 5 (7.8%) had residual defect. CONCLUSION: NC may be associated with serious complications in our setting. Adequate training of providers on safe procedure may minimize complications.

[Repraeputiatio glandis. Operations on circumcised men. Historical outline and technique]. / Repraeputiatio glandis. Operacje na obrzezanych. Rys historyczny i technika.

Historical outline of circumcision and its meaning for numerous societies. Circumcision is a very characteristic mark, especially for the confessors of Judaism. Nevertheless, it is known from the world history that during persecution periods it used to be a hidden seal. So, circumcision has been always accompanied by reconstruction operations, which had been known even in the ancient Rome. A number of such operations and attempts of reconstruction of prepuce grew considerably during the 2nd World War. The author presents his own operation materials and observations.