A Trade-Off Analysis of Routine Newborn Circumcision

Christakis, Dimitri A.; Harvey, Eric; Zerr, Danielle M.; Feudtner, Chris; Wright, Jeffrey A.; Connell, Frederick A.

doi:10.1097/00006254-200009000-00010

Cited by 43 publications

(58 citation statements)

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“…One study with good evidence estimates that based on having to do 909 circumcisions to prevent 1 penile cancer event, 2 complications would be expected for every penile cancer event avoided. 121 However, another study with fair evidence estimates that more than 322 000 newborn circumcisions are required to prevent 1 penile cancer event per year. 122 This would translate into 644 complications per cancer event, by using the most favorable rate of complications, including rare but significant complications.…”

Section: Cancer Penile Cancermentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

282

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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Section: Cancer Penile Cancermentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

282

149

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“…Aux USA, Christakiss et al [10] ont collig~ 33 accidents dus la circoncision en 9 ans. En France, Gross et al [14] Ont ~t6 inclus dans cette 6tude tousles patients admis et trait~s pour accident de la circoncision pendant la p~riode d'dtude et ayant un dossier mddical complet, c'est-~-dire une observation m~dicale et des examens compl~mentaires (num6ration et formule sanguines, bandelette urinaire, urographie intraveineuse, crase sanguine).…”

Section: Introductionunclassified

Circumcision complications: clinicopathological and therapeutic aspects based on 44 cases at Conakry Hospital, Guinea

Diallo¹,

Toure

Camara

et al. 2008

Androl.

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RESUMEObjectif: Pr~ciser les diff~rents aspects anatomo-cliniques et th~rapeutiques des accidents de la circoncision re(~us en milieu hospitalier guin(~en. Rdsultats : L'Sge moyen des patients b la rdception dtait de 14,9 + 8,3 ans avec des extr&mes de 10 jours et 32 ans. Le d~lai moyen de consultation en milieu sp6cialis(~ dtait de 16,8 _+ 2,3 mois avec des extr6mes de 2 heures et 37 mois et seuls 29,6 % (n = 13) des patients ont consult6 en milieu sp6cialisd durant la semaine de survenue de I'accident de circoncision. Patients et M~thodeLa circoncision avait ~t~ effectude par un agent paramddical dans 64 % des cas et par un tradipraticien dans 36%. Les Idsions dtaient domin(~es par les fistules ur(~tro-cutan~es (28 cas), les h#morragies p~niennes (10 cas) et les amputations du gland (2 cas). Certains accidents ~taient rares tels que la stdnose du mdat ur~tral et la r(~tention aigu6 d'urine v~sicale.Conclusion : Les accidents de la circoncision sont graves et peuvent engager le pronostic vital. Leur prdvention passe par une meilleure accessibilit~ des enfants aux structures sanitaires qualifi~es, et aussi par la formation du personnel r~alisant cet acte chirurgical.

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“…However, more credible analyses involving 100,000 and 354,297 US male infants each found the complication rate was 0.2%. 44,45 The latter then calculated that 6 UTIs could be prevented for every circumcision complication. 45 The RACP Statement cites this reference, but not these data, merely saying that "other figures can be used to come to a different conclusion".…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

“…[78][79][80] However, this ignores the two biggest studies in which rate was 0.2%. 44,45 Nevertheless, a range of opinion is apparent. The RACP Statement defines a complication as "haemorrhage, infection, glanular ulceration, meatal stenosis, inadvertent injury to the urethra (fistula), too much skin removed, anaesthetic complications, psychological trauma, secondary phimosis and secondary chordee."…”

Section: Complicationsmentioning

confidence: 99%

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RACP's policy statement on infant male circumcision is ill‐conceived

Morris

Bailis²,

Castellsagué

et al. 2006

Australian and New Zealand Journal of Public Health

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Objective:To conduct a critical peer‐review of the 2004 Policy Statement on routine male circumcision produced by the Royal Australasian College of Physicians (RACP). Method:Comprehensive evaluation in the context of the research field. Results:We find that the current Statement downplays the wide‐ranging life‐long benefits of circumcision in prevention of urinary tract infections (UTIs), penile and cervical cancer, genital herpes and chlamydia in women, HIV infection, phimosis, and various penile dermatoses, and at the same time overstates the complication rate. We highlight the many errors in the RACP Statement and note that it sidesteps making a conclusion based on circumcision's well‐documented prophylactic health benefits by instead referring to the status of the foreskin at birth. In the era of preventative medicine we view this as irresponsible. Conclusion:The RACP's Statement on routine male circumcision is not evidence‐based and should be retracted. Implications:In the interests of public health and individual well‐being an extensive, comprehensive, evidence‐based revision should be conducted so as to provide scientifically accurate, balanced information on the advantages, and also the low rate of mostly minor complications, associated with this simple procedure, which for maximum benefits and minimal risk should ideally be performed in the neonatal period.

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A Trade-Off Analysis of Routine Newborn Circumcision

Cited by 43 publications

References 0 publications

Male Circumcision

Male Circumcision

Circumcision complications: clinicopathological and therapeutic aspects based on 44 cases at Conakry Hospital, Guinea

RACP's policy statement on infant male circumcision is ill‐conceived

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