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Paediatric Policy - Circumcision

6. Complications Of 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:

  • Haemorrhage
  • Infection
  • Glanular ulceration
  • Meatal stenosis
  • Inadvertent injury of the urethra (fistula)
  • Too much skin removed
  • Loss of penis (1 in 1,000,000)
  • Anaesthetic complications
  • Psychological trauma
  • Secondary phimosis
  • Secondary chordee.

The 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.

6.1 Absolute 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)
  • Buried penis
  • Sick and unstable infants
  • Family history of a bleeding disorder or an actual bleeding disorder
  • Inadequate expertise and facilities.
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