Management of post-circumcision necrosis of the penis: the medicolegal aspect

Taşçı, Ali İhsan; Danacıoğlu, Yavuz Onur; Arikan, Yusuf; Çolakoğlu, Yunus; Yapar, B; Büyük, Yalçın

doi:10.1007/s00383-020-04630-2

Cited by 6 publications

(12 citation statements)

References 31 publications

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“…They are also usually incapable of diagnosing penile necrosis early enough; so, they are responsible for the delayed referral of those patients to the appropriate specialists. 3 The delayed transfer of patients is associated with a poor prognosis in this series of patients. Usually, inexperienced physicians manage post-circumcision bleeding by applying a compressive wound dressings for many hours.…”

Section: Discussionmentioning

confidence: 71%

“…2 The improper use of local anesthesia that contains vasoconstrictors is a major cause of penile ischemia. 3 The etiology of this vascular insult may be vascular spasm at the glans, which is secondary to aggressive surgical manipulations. Also, DPNB may be responsible for dorsal penile artery spasm because of vascular wall irritation or an erroneous injection into the deep dorsal vein of the penis, which leads to venospasm.…”

Section: Discussionmentioning

confidence: 99%

“…A study carried out by Tasci et al in 2020 reported that monopolar diathermy application constitutes the most signi cant risk factor for necrosis in penile surgeries. 3 If monopolar energy sources are used, the electrical ow can be transferred from the small penile bore and spread to the whole-penis 10 . Thermal damage can result in gangrene and the complete penile loss.…”

Section: Discussionmentioning

confidence: 99%

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Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

Fahmy

Sabra

Abdelmohsen

et al. 2022

Preprint

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Background: Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia.Material and methods: This cohort prospective observational study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for all cases. Data of patient age, anesthesia method, monopolar diathermy use, early presentation and positive wound culture were collected and analyzed statistically.Results: During the study period a 3,382 child were circumcised for non-medical reason; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%) Most of the penile ischemia is associated with use of monopolar diathermy (74%), compressive wound dressing to control post-circumcision bleeding and infections are responsible for ischemia in 52.2% and 43.5% of cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 hours had better outcomes than those who were presented later (p = 0.001).Conclusion: In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is effective, and reduces penile tissue loss.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

Fahmy

Sabra

Abdelmohsen

et al. 2022

Preprint

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“…Moreover, we demonstrated that electrical device usage might cause penile tissue innervating somatosensitive nerves and their ganglia injury. The following complications should be attributed to neural network collapse following circumcision: penile adhesion, skin bridges, meatal stenosis, redundant foreskin, recurrent phimosis, buried penis and penile rotation [28], residual foreskin, meatal stenosis, granuloma [29] and postcircumcision necrosis [30]. According to our clinical experiences, the granuloma is frequently developed from cauterised nerve endings [12].…”

Section: Clinical Implications Of the Studymentioning

confidence: 93%

Comparing the effects of current circumcision techniques on dorsal root ganglia: an experimental study

et al. 2021

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Background Circumcision is a surgical removal process of the preputium. Surgical excision and electric current cause neurodegeneration in the excised tissue-related neural network. This study investigates if circumcision and current surgical methods would cause histopathological changes in the penile tissue innervating pudendal nerve dorsal root ganglia. Results Vascular congestion occluded the microvessels, and degenerative changes were detected in postexcised penile tissue. Neuronal angulation, cytoplasmic condensation, nuclear shrinkage, and condensed nuclei were observed in the pudendal nerve ganglia. Moreover, the degenerated neuron (DN) densities of the pudendal nerve ganglia were 5 ± 2, 98 ± 22, 1093 ± 185, 236 ± 43 and 151 ± 19 in the control, the surgical circumcision, the monopolar cautery, the bipolar cautery and the thermocautery groups, respectively. Conclusions Although only the pudendal nerve endings are affected secondary to prepusium excision another pudendal axons can be damaged during bleeding control with cautery, the destruction of the neuron that sends this axon initiates a general inflammation in that ganglion. As a result, there may be a somatosensitive innervation defect in extrapenile tissues innervated by this ganglion. High-voltage electric devices should not be used unless obligatory.

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“…Accelerating blood supply and oxygenation help to improve timely and reduce subsequent complications. This complication is followed by compressing the wound dress, local anesthesia that leads to a dorsal nerve block, and malpractice in using rings (5). This article describes a neonate with penile ischemia after circumcision who was treated with oral pentoxifylline.…”

Section: Introductionmentioning

confidence: 99%

Glans Ischemia Treatment with Pentoxifylline Following Circumcision in a Neonate

et al. 2021

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Introduction: Circumcision is the most common surgery in male infants in Islamic countries. Therefore, knowledge of its side effects and appropriate therapies is essential. Case Presentation: In this case report, we describe a 12-day neonate with glans ischemia, two days after circumcision. We admitted the neonate and treated him with oral pentoxifylline and antibiotic for three days. Conclusions: Thus, pentoxifylline can be implemented as a treatment in post-circumcision ischemia of the glans penis in neonates.

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Management of post-circumcision necrosis of the penis: the medicolegal aspect

Cited by 6 publications

References 31 publications

Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

Comparing the effects of current circumcision techniques on dorsal root ganglia: an experimental study

Glans Ischemia Treatment with Pentoxifylline Following Circumcision in a Neonate

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