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The Story Of Human Circumcision In Human History
Mehmet Ali Özen, Gökhan Gündoğdu, Mehmet Taşdemir , Egemen Eroğlu
Introduction: Meatal stenosis (MS) is a known complication of newborn circumcision. Symptoms are usually masked in young kids with a diaper. Deflation of urinary stream, dysuria, urinary frequency, and incontinence are the most common reported symptoms. Diagnosis of MS is still controversial. A narrow pinpoint urethral meatus is the current accepted diagnostic criteria.
Objective: In our practice, we observed that our cases do not overlap to the classic definition and presentation of MS. In this study, we presented our cases and aimed to share our observations.
Materials and methods: Records of children who had meatoplasty between 2014 with 2016 were analyzed retrospectively. Only children with MS who had had newborn circumcision performed in our clinic were included in the study. Over 500 newborn circumcisions are performed per year in our clinic using the Gomco Clamp technique. Age at diagnosis, presenting complaints, penile anomalies including urethral meatus configuration, urinary symptoms, operation methods, and postoperative follow-up were gathered.
Results: A total of 13 boys who were circumcised in the newborn period had undergone meatoplasty with the diagnosis of MS. The mean age at the time of meatoplasty was 52.5 ± 17.9 (range 37-93 months). All children were examined before and during the circumcision. There were no associated penile anomalies, including MS. The only presenting complaint was upward deflation of urinary stream instead of other lower urinary tract symptoms. Although the appearance of the meatus was pinpoint in all cases (Figure); it was easy to calibrate with an 8-10 Fr feeding tube. There was no stenosis, but a ventral web was detected. Meatoplasty with removal of this web was performed under general anesthesia. Two sutures were applied at 5 and 7 o’clock with 7/0 PDS. Mean postoperative follow-up time was 16.9 ± 7.5 months. Children were pleased with direction of urinary stream.
Discussion: Both the diagnosis and morphological definition of MS have some controversies. To our knowledge, there is no similar reported study with pinpoint appearance and normal calibration of the meatus. There was no stenosis in any of them. Unlike classical MS presentations, upward deflation of urinary stream resulting from ventral web was a single presenting complaint.
Conclusions: Upward deflation of urinary stream can develop after neonatal circumcision because of a meatal web without stenosis, and can be cured easily with meatoplasty. Instead of ‘meatal stenosis’, ‘meatal web’ may be a more appropriate term to explain the pathology in these patients.
Isolated penile torsion in newborns
Egemen Eroglu, Gokhan Gundogdu
Introduction: We reported on the incidence of isolated penile torsion among our healthy children and our approach to this anomaly.
Methods: Between 2011 and 2014, newborn babies with penile torsion were classified according to the angle of torsion. Surgical correction (penile degloving and reattachment for moderate cases and dorsal dartos flap technique in case of resistance) after 6 months was advised to the babies with rotations more than 45°.
Results: Among 1000 newborn babies, 200 isolated penile torsions were found, and among these, 43 had torsions more than 45°, and 4 of these had angles greater than 90°. The mean angle of the rotations was found 30.45° (median: 20°). In total, 8 children with 60° torsions were previously circumcised. Surgery was performed on 19 patients, with a mean patient age of 12 ± 2 months. Of these 19, 13 babies were corrected with degloving and reattachment. This technique was not enough on the remaining 6 patients; therefore, derotational dorsal dartos flap was added to correct the torsion. After a mean of 15.6 ± 9.8 months, residual penile rotation, less than 15°, was found only in 2 children.
Conclusion: The incidence of isolated penile torsion is 20% in newborns. However, rotation more than 45° angles are seen in 4.3% of male babies. Correction is not necessary in mild degrees, and penile degloving with reattachment is enough in most cases. If the initial correction is insufficient, dorsal dartos flap rotation is easy and effective. Prior circumcision neither disturbs the operative procedure nor affects the outcomes.
Buried penis after newborn circumcision
Egemen Eroğlu, Okan W Bastian, Hilda C Ozkan, Ozlem E Yorukalp, Ayla K Goksel
Purpose: Buried penis may develop after circumcision, mostly during infancy, presumably due to peripubic fat. A surgical approach may be recommended for psychological benefits to patients and parents, and because it is believed that this condition will not improve on its own with time. The aim of this study was to assess the natural history of buried penis after newborn circumcision.
Materials and methods: During a routine visit to the pediatrician infants with buried penis were assessed by a single pediatric surgeon between January 2004 and June 2007. In December 2007 all of these children were reexamined by the same pediatric surgeon and the natural growth of the genitalia was analyzed.
Results: A total of 88 infants were enrolled in the study. When they were first examined they were 3 to 6 months old (mean 3.3). In December 2007, after reexamination, patients were divided into groups based on age, including those younger than 1 year (14 patients), 1 to 3 years (59) and older than 3 years (15). The aspect of the genitalia was evaluated by the same pediatric surgeon for each patient. Buried penis was noted in 14 of 14 patients younger than 1 year (100%), 19 of 59 patients 1 to 3 years old (32.2%) and 1 of 15 patients older than 3 years (6.7%).
Conclusions: Buried penis after newborn circumcision is not permanent. As infants get older, and after beginning to walk, the appearance usually turns out to be normal. This resolution may be due to growth and/or maturation alone. Based on our results, we do not recommend surgery for buried penis in children younger than 3 years.
Does circumcision increase neonatal jaundice?
Eroğlu E, Balci S, Ozkan H, Yörükalp O, Göksel A, Sarman G, Dayanikli P.
Purpose: The aim of this study was to evaluate the effects of circumcision done during the early newborn period on the baby’s feeding frequency and therefore a possible effect on serum bilirubin values.
Methods: Sixty consecutive male patients, of whom 30 were circumcised, were comparatively followed. Babies born between 35 and 40 gestational weeks, weighing above 3000 g and who had no antenatal and/or perinatal problems were enrolled. Changes in weight, frequency of feeds, urination, stooling and the serum bilirubin levels were compared.
Results: There was no statistically significant difference between the two groups.
Conclusion: In experienced hands, newborn circumcision on the second day of life is safe, does not affect babies’ feeding frequency or bowel movements on day 3, and does not increase serum bilirubin on day 4, thus does not increase the risk of neonatal jaundice.