Circumcision Complications: How a Botched Circumcision can be Fixed?

Circumcision is an operation done to remove the foreskin so as to leave the glans penis uncovered. It is believed to be one of the oldest surgical procedures in the world. It began as a religious tradition and currently almost one sixth of all the males of the world are said to be circumcised on the basis of religious grounds. Circumcised mummies dating back to the Egyptian civilization have been found. It is a common practice both in Jews and Muslims. And yet, despite its wide prevalence, circumcision remains an operation that is often associated with complications.

 

Common Complications Associated with Circumcision

Let us look at some of the common complications associated with circumcision.

• Bleeding: Bleeding is the most common complication of circumcision. It may occur from a discreet blood vessel present at the frenulum or may occur from the edge of the skin between the sutures. In most of the cases, application of pressure or silver nitrate at the site of bleeding is enough to control it.

• Infection: This can be seen usually in small babies undergoing the procedure because of the bacteria present in the diapers. Rarely, the skin flora may also be responsible for the infection.

• Trapped Penis: In case of subjects with prominent fat pad in the suprapubic region, if excessive shaft skin is removed, the penis heals within the fat and becomes concealed. Experts advise that the fat should be compressed against the abdominal wall and then, the amount of skin to be excised should be determined in order to avoid this complication. The suprapubic fat should also be compressed at regular intervals after the surgery so that the penis can protrude. If these factors are not taken into consideration, corrective surgery may be required at a later stage to free the penis.

• Inadequate Removal of the Foreskin: It is a fairly common complication of circumcision surgery. In some cases this may lead to phimosis which may require corrective surgery wherein the redundant skin is removed.

• Meatal Stenosis and Meatitis: Removal of the prepuce subjects the meatus to persistent irritation. Erythema of the meautus may lead to its infection. The condition is usually self-limiting and may improve with the topical application of antibiotic. However, in certain cases, the ligation of frenular artery may lead to meatal stenosis. This accounts for almost 26% of the late complications associated with circumcision. In case the patient suffers from urgency because of inadequate emptying of the bladder, dripping or deflection of the stream of urine , he may have to undergo meatoplasty at a later stage.

• Urethro-Cutaneous Fistula: It is a rare complication that may occur because of wrong surgical techniques. It may lead to a fistulous tract and the urine stream may become divided. Corrective surgery is required.

• Necrosis of the Glans: Use of electro-cautery during the circumcision procedure has been associated with the necrosis of the glans penis. Although rare, this complication is often associated with disastrous results when the entire glans gets amputated.

• Hypospadias: In case the surgeon is inexperienced, he may enter the wrong plane and may give a ventral slit for lysis instead of a dorsal slit. This may result in hypospadias.

We see that circumcision can be a risky surgery if it is not performed by expert hands. While most of the complications are minor and amenable to corrective surgeries, certain complications like the necrosis or amputation of glans may have disastrous consequences. The penile transplant surgery, recently performed in South Africa has come as a ray of hope for such patients.

 

Reference:

“Complications of Circumcision,” by Aaron J. Krill, Jeffery S Palmer, et all, published in the Scientific World Journal in December 2011, accessed on May 11, 2015. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253617/