Paediatric Policy - Circumcision
Apart from pain and distress, and the side effects of local
anaesthesia, there have been many complications of circumcision reported5,60,61.
Most complications are minor, but some can be more severe, such as penile amputation
and even death. The overall reported rate of complications after circumcision
varies between 0.06%62 to 55%63
depending on the situation in which it is performed and the precise definition
of complication. Most series describe a complication rate of about 2-10%64-66.
A detailed summary of complications has been provided by Williams and Kapila61,
and includes the following:
- Meatal stenosis
- Inadvertent injury of the urethra
- Too much skin removed
- Loss of penis (1 in 1,000,000)
- Anaesthetic complications
- Secondary phimosis
- Secondary chordee.
true incidence of major complications after newborn circumcision is unknown
but is reported to be from between 0.2% and 0.6%5
to 2-10%61. The most frequent acute problem
is haemorrhage, and may indicate an underlying vitamin K deficiency or haemophilia.
Infection is usually minor, but rarely septicaemia and meningitis may occur.
Longer term complications include meatal stenosis, cutaneous tags, poor cosmetic
appearance, and psychological trauma. Children with prominent prepubic fat may
have a concealed penis following surgery which tends to resolve at puberty.
Contraindications To Neonatal Circumcision
Contraindications to routine
neonatal circumcision include:
- Hypospadias and other congenital anomalies
of the penis, e.g. epispadias
- Chordee (ventral angulation of the penis)
- Sick and unstable infants
- Family history of a bleeding
disorder or an actual bleeding disorder
- Inadequate expertise and facilities.