Circumcision-related tragedies seen in children at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Abstract

BackgroundCircumcision is a common minor surgical procedure and it is performed to a varying extent across countries and religions. Despite being a minor surgical procedure, major complications may result from it. In Ghana, although commonly practiced, circumcision-related injuries have not been well documented. This study is to describe the scope of circumcision-related injuries seen at the Komfo Anokye Teaching Hospital in Kumasi, Ghana.MethodsThe study was conducted at the Urology Unit of the Komfo Anokye Teaching Hospital in Kumasi. Consecutive cases of circumcision-related injuries seen at the unit over an 18 month period were identified and included in the study. Data was collected using a structured questionnaire. Data was entered and analysed using SPSS version 16. Charts and tables were generated using Microsoft Excel.ResultsA total of 72 cases of circumcision-related injuries were recorded during the 18 month period. Urethrocutaneous fistula was the commonest injury recorded, accounting for 77.8 % of cases. Other injuries recorded were glans amputations (6.9 %); iatrogenic hypospadias (5.6 %), and epidermal inclusion cysts (2.8 %). The majority of children were circumcised in health facilities (75 %) and nurses were the leading providers (77.8 %). The majority of circumcisions were conducted in the neonatal period (94.7 %).ConclusionCircumcision-related injuries commonly occurred in the neonatal period. Most of the injuries happened in health facilities. The most common injury recorded was urethrocutaneous fistula but the most tragic was penile amputation. There is the need for education and training of providers to minimise circumcision-related injuries in Ghana.

An assessment of the training and practice of circumcision by medical circumcisers in Ghana

“…It is possible that there are other late complications including urethrocutaneous fistulae, penile skin bridges, epidermal inclusion cysts and even glans or penile amputations that may not have reported to them. This is because most parents report late complications of circumcision to urologists and not to the circumciser as they do not attribute the complication to the circumcision procedure due to the long period it takes for the complications to manifest [3,7]. In Uganda, it was shown that even trained doctors needed to complete 100 circumcisions to significantly reduce the incidence of adverse events of circumcision [8].…”

“…In infants and neonates, it is safest to use techniques such as the device methods with Plastibel or Gomco clamp which protect the glans penis or use surgical techniques like the dorsal slit or sleeve technique where excision of foreskin is done with the glans penis in view to reduce the risk of injury to it [11]. In the study by Appiah et al on circumcision related tragedies in Ghana, almost 7% (5 out of 72) of the complications were penile amputations, mostly due to forceps guided/amputation technique [3]. In this study, the forceps guided technique/ amputation technique was the most common technique used despite the fact that in neonates and infants, this technique risks injuring the glans or the phallus due to its relatively small size.…”

“…experienced providers, Appiah et al documented that most circumcision related injuries in Ghana resulted after circumcision by health care professionals who perform these circumcisions in hospitals and other healthcare facilities [1,3]. In fact, in a population based study in rural Ghana, Gyan et al observed that comparatively, hygiene practices such as hand washing, cleaning of the penile area and cleaning of instruments were poorer among formal healthcare professionals than informal providers [4].…”

“…There are various kinds of health care professionals performing circumcision in the health facilities without proper training, resulting in serious circumcision related tragedies such as penile amputations, urethrocutaneous fistulae, glans or penile ischemic necrosis, etc. [3].…”

A rare complication following circumcision, severe urethral fistula located on the distal penile shaft and the coronal margin: A case report

“…Although there are numerous reports of circumcision complications, the most frequently known and reported complication is hemorrhage and wound site infection [4,5]. Urethral fistula is not a very common complication [6,7]. In this paper, we present a two-year-old male patient with severe penile and urethral trauma with severe urethral fistula after circumcision.…”