Table 1

Prospective studies of frequency of complications in studies of neonatal and infant circumcision

Author

Country

No. of patients

Age

Type of provider

Method

Follow-up period

Frequency of adverse eventsa

Frequency of serious adverse eventsb


Al Samarrai [11]

Saudi Arabia

2000

2-3 days

Junior staff with supervision

Plastibell

6 weeks plus immunisation clinic visits

1.4%c

0%


Amird [21]

Saudi Arabia

1000

Mean 9 days

Surgeon

Gomco clamp

1 year

1.6%

0%


Banieghbal[32]

South Africa

583

Neonatal

Surgeon

Gomco clamp

1 month

0.3%

0%


Ben Chaim [9]

Israel

19,478

Mean 8 days

83% Mohel

17% Physician

Freehand

-

0.1%

0.1%


Bhat [22]

Oman

250

Neonatal

(min 1 day)

Paediatrician

Plastibell

-

0%

0%


Duncan [23]

Jamaica

205

Neonatal

Surgeon

Plastibell

1 week

1.5%

0%


Horowitz [24]

USA

130

98 neonatal

32 infants (3-8.5 months)

Pediatric urologist

Gomco clamp

3 days

Overall: 7.4%

Neonatal: 0%

Infants: 30%

0%


Manji [25]

Tanzania

368

7 days to 9 months

Pediatrician

Plastibell

-

2.8%e

0%


Mousavi [33]

Iran

586

<12 months

Surgeon

50% sleeve

50% Plastibell

-

Sleeve: 1.95%

Plastibell: 3.1%f

Sleeve: 0%

Plastibell 2.1%


Okafor [26]

Nigeria

102

Immediate post-partum

Experienced surgeon

Plastibell

1 year

0%

0%


Okekeg [10]

Nigeria

322

8 days-13 months

55% Nurses

35% Doctors

9% Trad.

-

3 month

9.3%

1.0%


Osuigwe [27]

Nigeria

141

7-9 days

54% Doctors

44% Midwives

2% Trad. birth attendants

68% Plastibell

31% freehand

6 weeks

13.5%

Plastibell: 8%

Freehand: 27.3%

2.1%


Palit [28]

UK

1129

Mean age 11 weeks

Trained nurses under supervision of consultant urologists

Plastibell

3 months

5.5%

0.1%


Pateld [29]

Canada

100

3-5 days old

98% Medical doctors

2% Traditional Providers

51% Gomco

47% Plastibell

2% Ritual

-

15%h

2%


Perlmutter [30]

USA

51

Neonatal

Obstetrician or resident

Gomco

Up to 2 hours

0%

0%


Rehman [31]

Pakistan

200

Infant

Surgeon

50% freehand 50% bonecutter

1 week

16%

0.5%


a Cases of minor bleeding stopped with simple pressure or 'conservative management' and excessive foreskin/inadequate circumcision are not included

b Includes complications defined as 'serious' or 'severe' by authors, or with long-term or life-threatening sequalae (partial amputation of glans, urethral laceration, need for re-surgery or plastic surgery)

c 18 patients with yellowish patches of sloughed tissue and erythema who did not have an infection confirmed through cultures, 4 patients with irregular skin margin and 4 patients with inadequate skin excision were excluded

d In these studies patients who had undergone circumcision were identified retrospectively, but wherever possible patients were actively followed up to obtain accurate complication risks.

e Risks by age at circumcision: 7-14 days: 0.9%; 15 days - 2 months: 4.7%; 2 - 9 months: 11.5%

f Excludes 'excess mucosa' and 'delayed Plastibell falling off'

g Patients were identified through an immunization clinic and a physical examination was conducted to confirm circumcision status and the presence and type of complications. Uncircumcised boys were followed up to identify boys circumcised at a later age and any complications

h 31 cases of mild oozing, 7 cases of mild infection with no antibiotic treatment were excluded

Weiss et al. BMC Urology 2010 10:2   doi:10.1186/1471-2490-10-2

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