From the Guidelines
Circumcision can lead to various complications, including recurrence of urethral stricture, Koebnerization of lichen sclerosus in the circumcision scar, and persistent lesions of lichen sclerosus despite circumcision 1.
Common Complications
- Urethral stricture: This complication appears to be most common in those having a one-stage repair rather than stricture excision with a two-stage repair 1.
- Koebnerization: This phenomenon may explain the recurrence of urethral stricture and the development of new lesions of lichen sclerosus in the circumcision scar 1.
- Persistent lesions of lichen sclerosus: One series showed that 50% of men requiring circumcision continued to have lesions of lichen sclerosus, indicating that circumcision does not always ensure protection against further flares of the disease 1.
Important Considerations
- Surgical margins: Recent studies have shown that surgical margins of 5 to 10 mm are as safe as 2-cm surgical margins, and 10- to 20-mm margins provide adequate tumor control 1.
- Follow-up: Patients who undergo circumcision should be reviewed after surgery, and those with active ongoing disease will require long-term follow-up to assess symptoms and detect potential complications 1.
- Referral to specialist services: Patients with urinary symptoms or suspected complications should be referred to a urologist for further evaluation and management 1.
From the Research
Complications of Circumcision
The complications of circumcision can be severe and varied. Some of the most common complications include:
- Preputio-glandular fusion, meatal stenosis, urethral fistula, partial glandular amputation, and opening distal urethra 2
- Partial circumcision, post-circumcision bleeding, and urethrocutaneous fistula 3
- Local infectious complications such as staphylococcal and streptococcal infections, cellulitis, impetigo, pyoderma, necrotizing fasciitis, scalded skin syndrome, Fournier gangrene, glanular necrosis, scrotal abscess, and peritonitis 4
- Systemic infectious complications including bacteremia, wound sepsis, and meningitis 4
Risk Factors for Complications
The risk of complications is higher when circumcision is performed by untrained or unlicensed individuals, or in non-sterile environments 3, 5. The use of sterile techniques and effective pain management can reduce the risk of infectious complications 4.
Prevention of Complications
To prevent complications, circumcision should be performed by educated and experienced personnel in a sterile environment 2, 4, 5. Training, guidance, and policy interventions are needed to reduce the incidence of circumcision-related mishaps 3. Public health campaigns can also help to dissuade non-surgeon circumcisers from performing circumcisions, especially on children with hypospadias 3.