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Open Access Journal of Urology & Nephrology Research Article 4 min read

Complications of Ritual Male Circumcision in Developing Countries

<p>Nandiolo KR*</p>*
* Corresponding author
ISSN: 2578-4676  10.23880/oajun-16000134  Received: January 31, 2018  Published: February 05, 2018
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Editorial

Circumcision is practice since antiquity [1, 2]. In all countries, Therapeutic circumcision is practiced for hygiene reasons [3], to reduce the risk of infection or handle a male genital organ [4]. Circumcision is commonly done in Africa for ritual and religious reasons [5]. Though to be a common procedure, circumcision led to severe complications and sequelae. The length of the administrative procedures [6] in touch with general anesthesia, as well as the high cost of the circumcision in medical environment (88.26 € / 100.72 $ to 47.95 € / 54.72 $ versus 3.77 € / 4.17 $), encourage the practice of traditional circumcision. It is made by the itinerant or community circoncisionist. Prepuce is tightened between the thumb and the index, stretched out and excise with the knife [7]. In the African countries the age of the circumcision is function of habits and customs of the populations. Ahmed [8] reports an average age of 4 years and Dieth [6] 28 months. The period of referral for consultation was variable. It seems directly related to the type of the lesion observed at the patients. Diallo A.B in Guinea [9], and Sylla [5] noticed that the period of referral varies from 2 hours to 37 months with shorter period in the cases bleedings, than in fistulas and meatal stenosis [5]. The clinical presentation is dominated by the bleeding [6]. Other complications reported in the literature are: infections [3, 5, 6], urethral stenosis, iatrogenic hypospadias [3], partial or total Amputation of glans [4, 6, 8], urethral fistula. The urethral fistula can be considered as a complication or sequelae of the circumcision. According to the majority of the authors [3, 5] the fistula is located preferentially in the neck of glans because the urethra is there more superficial at this level, and possible balano preputial adhesions increase its vulnerability [5]. Meatal stenosis is related to 2.3 % [9] to 53 % [6] of the traditional circumcision. It is a late complication of the circumcision and it is secondary to an unnoticed small trauma, or an infection [3, 5]. A broad- spectrum and well led antibiotic treatment allows to fight against the infection. Burying penis occurs when the penis tends to retract under the suprapubic fat pad; secondarily the circular wound heals and narrows by imprisoning the penis below the cutaneous cover of the pubis [4]. Certain anatomical variations such as the penoscrotal webbing, the excess of panicle fat above pubic, were identified as being possible contributing factors of this complications of the circumcision [10]. The partial amputations of the penis are treated by debridement followed by a meatoplasty associated or not with a prepucial plasty. Those seen within less than 6 hours can benefit from a reimplantation of the amputated penis [11]. The reimplantation of the penis is possible even beyond the 6th hours [11, 12, 13]. So, Scherman [11] reported a good vitality of reconstructed penis till the 8th hour after the trauma. Hashem FK described a case of amputation of the penis secondary to a ritual circumcision in a 04 years old child, handled successfully 18 hours after the accident [13, 14, 15].

Conclusion

The reduction of the complications rate of traditional circumcision should be consider by the reduction of the cost of the circumcision in specialized medical environment, and the training of the agents realizing the circumcision in traditional environment.

References

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  9. Diallo AB, Bah I, Barry M, Bah OR, Balde S, et al. (2006) La fistule pénienne après circoncision. A propos de 22 cas. Afr J Urol 12 (3): 152-155
  10. Mayer E, Caruso DJ, Ankem M, Fisher MC, Cummings KB, et al. (2003) Anatomic variants associated with newborn circumcision complications. CJU 10(5): 2013-2016.
  11. Sherman J, Borer JG, Horowitz M, Glassberg KT (1996) Circumcision: successful glanular reconstruction and survival following. J Urol 156: 842-844.
  12. De Lagausie P, Jehanno P (2008) Six years follow-up of a penis replantation in a child. J paediatr surg 43(3): e11-e12.
  13. Hashem FK, Ahmed S, Al-Malq AA, Abu Daia JM(1999) Successful replantation of penile amputation (post- circumcision) complicated by prolonged ischaemia. Br J Plast Surg 52(4): 308-310.
  14. Ba M, Ndoye A, Fall Pa, Sylla C, Gueye SM, et al. (2000) Penile urethral fistula after circumcision. Andrologie 10: 75-77.
  15. Ben Chaim, Livne PM, Binyamini J, Hardak B, Ben- Meir D, et al. (2005) Complications of circumcision in Israel: a one year multicenter survey. Isr Med Assoc J 7(6): 368-370.
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@article{nandiolo2018,
  title   = {Complications of Ritual Male Circumcision in Developing Countries},
  author  = {Nandiolo KR},
  journal = {Open Access Journal of Urology & Nephrology},
  year    = {2018},
  volume  = {3},
  number  = {1},
  doi     = {10.23880/oajun-16000134}
}
Nandiolo KR (2018). Complications of Ritual Male Circumcision in Developing Countries. Open Access Journal of Urology & Nephrology, 3(1). https://doi.org/10.23880/oajun-16000134
TY  - JOUR
TI  - Complications of Ritual Male Circumcision in Developing Countries
AU  - Nandiolo KR
JO  - Open Access Journal of Urology & Nephrology
PY  - 2018
VL  - 3
IS  - 1
DO  - 10.23880/oajun-16000134
ER  -