Русский
Penile glans amputation during circumcision: causes, treatments and preventive measures
DOI: https://dx.doi.org/10.18565/urology.2021.4.79-86
Y.E. Rudin, V.I. Runenko, D.V. Marukhinenko, D.K. Aliev, A.Y. Rudin
1) Department of Pediatric Urology of N.A. Lopatkin’s Research Institute of Urology and Interventional Radiology – a branch of the FSBU «NMSC of Radiology» MH of the Russian Federation, Moscow, Russia; 2) Urology Department of St. Vladimir Children Hospital DSM, Moscow, Russia
Introduction. Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures.
Materials. Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons.
The results. The operations were performed by local anesthesia, at home – in 5 patients, in 1 child – at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks).
Conclusion. Visual control of the glans position during circumcision will prevent the amputation. «Guillotine» techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.)
Materials. Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons.
The results. The operations were performed by local anesthesia, at home – in 5 patients, in 1 child – at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks).
Conclusion. Visual control of the glans position during circumcision will prevent the amputation. «Guillotine» techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.)
Keywords: amputation of the glans penis during circumcision, complications of circumcision, circumcision techniques, circumcision
About the Autors
Corresponding author: D.K. Aliev – junior researcher of Department of pediatric urology, N.A. Lopatkin Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Center of Radiology, Moscow, Russia; e-mail: j.k.aliev@gmail.com
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