Phimosis and Circumcision: Concepts, History, and Evolution

Document Type : Narrative Review

Authors

1 Federal University of Piauí, Piauí, Brazil

2 Federal University of Paraná, Paraná, Brazil

Abstract

Phimosis is classically characterized by the impossibility of completely withdrawing the foreskin and exposing the glans. A distal preputial narrowing occurs, which may be congenital or acquired. Excess foreskin and the presence of balanopreputial adhesions may be components of this spectrum. Circumcision corresponds to foreskin excision, one of the most commonly performed surgeries in boys, whether for medical or religious reasons. Such a procedure is considered sacred by many peoples around the world as a symbol of faith or even as a ritual of tribal emancipation. The appearance of the procedure in several places and times allowed the development of the surgical technique, today adapted to minimize complications and provide evident medical benefits. We present fundamental physiological and histological concepts, classically described, knowing the natural history of a potential disease. We discuss the emergence and development of surgical techniques still used today and identify factors that interfere with the disease and influence the treatment.

Keywords

References

  1. Austin PF. Circumcision. Curr Opin Urol. 2010;20(4):318-322. doi:10.1097/MOU.0b013e328338e4fe.
  2. Braz A. [Phimosis: what you should know about]. Pediatr Mod. 2014;50(7):338-348.
  3. Gairdner D. The fate of the foreskin, a study of circumcision. Br Med J. 1949;2(4642):1433-1437, illust. doi:10.1136/bmj.2.4642.1433.
  4. Oster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968;43(228):200-203. doi:10.1136/adc.43.228.200.
  5. Deibert GA. The separation of the prepuce in the human penis. The Anatomical Record. 1933;57(4):387-399. doi:10.1002/ ar.1090570409.
  6. Carnevale J, Miranda EG, Silveira AE, Tiburcio MA. Tratado de Urologia Pediátrica. Editora Sparta; 2013.
  7. Simpson ET, Barraclough P. The management of the paediatric foreskin. Aust Fam Physician. 1998;27(5):381-383.
  8. Naimer SA, Zega K, Silverman WF. Anatomy of the cutaneous surface of the male genitalia, with elaboration upon the inner preputial coronal-shaft junction. J Pediatr Urol. 2016;12(1):53. e51-55. doi:10.1016/j.jpurol.2015.06.022.
  9. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996;77(2):291-295. doi:10.1046/j.1464-410X.1996.85023.x.
  10. Wright JE. Further to “the further fate of the foreskin”. Update on the natural history of the foreskin. Med J Aust. 1994;160(3):134- 135.
  11. Parkash S, Jeyakumar S, Subramanyan K, Chaudhuri S. Human subpreputial collection: its nature and formation. J Urol. 1973;110(2):211-212. doi:10.1016/S0022-5347(17)60164-2.
  12. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol. 1996;156(5):1813-1815. doi:10.1016/S0022-5347(01)65544-7.
  13. Rickwood AM, Walker J. Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? Ann R Coll Surg Engl. 1989;71(5):275-277.
  14. Laurini HC, Tractenberg M, Cohen M, Margulies M, Blank P, Kacelnik Z. A Circuncisão: o Mito e o Rito. Rio de Janeiro: Documentário; 1974.
  15. Bartone FF, King LR. Abnormalities of the Urethra, Pênis, and Scrotum. In: Welch KJ, Randolph J, Ravitch MM, O’Neill JA Jr, Rowe MI, eds. Pediatric Surgery. Chicago: Year Book Med Pub Inc; 1986:1314-1324.
  16. Johnston JH. Circumcision. In: Frank JD, Johnston JH, eds. Operative Paediatric Urology. London: Churchill Livingstone; 1990:221-225.
  17. Wilkinson DJ, Lansdale N, Everitt LH, et al. Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans. J Pediatr Surg. 2012;47(4):756- 759. doi:10.1016/j.jpedsurg.2011.10.059.
  18. Braz A. [Phimosis and circumcisions: a controversy in relation to procedures]. Pediatr Mod. 1999;35(3):108-119.
  19. Uson AC, Lattimer JK. Abnormalities of the Pênis and Scrotum. In: Ravitch MM, Welch KJ, Aberdeen E, Randolph J, eds. Pediatric Surgery. Chicago: Year Book Med Pub Inc; 1979:1338-1344.
  20. Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000;56(2):307-310. doi:10.1016/S0090-4295(00)00576-8.
  21. Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int. 2001;87(3):239-244. doi:10.1046/j.1464-410x.2001.02033.x.
  22. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003;169(3):1106-1108. doi:10.1097/01.ju.0000048973.26072.eb.
  23. Yang SS, Tsai YC, Wu CC, Liu SP, Wang CC. Highly potent and moderately potent topical steroids are effective in treating phimosis: a prospective randomized study. J Urol. 2005;173(4):1361-1363. doi:10.1097/01.ju.0000156556.11235.3f.
  24. Zampieri N, Corroppolo M, Camoglio FS, Giacomello L, Ottolenghi A. Phimosis: stretching methods with or without application of topical steroids? J Pediatr. 2005;147(5):705-706. doi:10.1016/j.jpeds.2005.07.017.
  25. Letendre J, Barrieras D, Franc-Guimond J, Abdo A, Houle AM. Topical triamcinolone for persistent phimosis. J Urol. 2009;182(4 Suppl):1759-1763. doi:10.1016/j.juro.2009.03.016.
  26. Nascimento FJ, Pereira RF, Silva JL, 2nd, Tavares A, Pompeo AC. Topical betamethasone and hyaluronidase in the treatment of phimosis in boys: a double-blind, randomized, placebo-controlled trial. Int Braz J Urol. 2011;37(3):314-319. doi:10.1590/S1677-55382011000300004.
  27. Puig Sola C, Garcia-Algar O, Vall Combelles O. [Childhood circumcision: review of the evidence]. An Pediatr (Barc). 2003;59(5):448-453. doi:10.1016/S1695-4033(03)78759-1.
  28. Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect. 1998;74(5):368-373. doi:10.1136/sti.74.5.368.
  29. Kaicher DC, Swan KG. A cut above: circumcision as an ancient status symbol. Urology. 2010;76(1):18-20. doi:10.1016/j.urology.2010.01.056.
  30. Gollaher D. Circumcision: A history of the world’s most controversial surgery. New York: Basic Books; 2000.
  31. Grene D. Herodotus: The History. Chicago: University of Chicago Press; 1987.
  32. Bolande RP. Ritualistic surgery--circumcision and tonsillectomy. N Engl J Med. 1969;280(11):591-596. doi:10.1056/NEJM196903132801105.
  33. Hodges FM. The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme. Bull Hist Med. 2001;75(3):375-405. doi:10.1353/bhm.2001.0119.
  34. Darby R. The masturbation taboo and the rise of routine male circumcision: A review of the historiography. J Soc Hist. 2003;36(3):737-757. doi:10.1353/jsh.2003.0047.
  35. Morales Concepcion JC, Cordies Jackson E, Guerra Rodriguez M, Mora Casaco B, Morales Aranegui A, Gonzalez Fernandez P. [Should circumcision be performed in childhood?]. Arch Esp Urol. 2002;55(7):807-811.
  36. Dewan PA, Tieu HC, Chieng BS. Phimosis: is circumcision necessary? J Paediatr Child Health. 1996;32(4):285-289. doi:10.1111/j.1440-1754.1996.tb02554.x.
  37. Holman JR, Stuessi KA. Adult circumcision. Am Fam Physician. 1999;59(6):1514-1518.
  38. Brisson PA, Patel HI, Feins NR. Revision of circumcision in children: Report of 56 cases. J Pediatr Surg. 2002;37(9):1343-1346. doi:10.1053/jpsu.2002.35005.
  39. Silva CB, Alves MC, Cabral Ribeiro J, dos Santos AR. Fimose e Circuncisão. Acta Urol. 2006;23(2):21-26.
  40. de Souza JC. Cirurgia Pediátrica – Teoria e Prática. Roca; 2008.
  41. Turk E, Karaca F, Edirne Y. Determining external genital abnormalities with a pre-circumcision examination in previously undiagnosed male school children. Urol J. 2014;11(2):1411-1414.
  42. Baky Fahmy MA. The spectrum of genital median raphe anomalies among infants undergoing ritual circumcision. J Pediatr Urol. 2013;9(6 Pt A):872-877. doi:10.1016/j.jpurol.2012.11.018.
  43. Salomon JA, Hogan DR, Stover J, et al. Integrating HIV prevention and treatment: from slogans to impact. PLoS Med. 2005;2(1):e16. doi:10.1371/journal.pmed.0020016.
  44. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657-666. doi:10.1016/S0140-6736(07)60313-4.
  45. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643-656. doi:10.1016/S0140-6736(07)60312-2.
  46. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298. doi:10.1371/journal.pmed.0020298.
  47. Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS. 2000;14(15):2361-2370. doi:10.1097/00002030-200010200-00018.
  48. Carael M, Holmes KK. Dynamics of HIV epidemics in sub-Saharan Africa: introduction. AIDS. 2001;15 Suppl 4:S1-4. doi:10.1097/00002030-200108004-00001.
  49. Auvert B, Buve A, Lagarde E, et al. Male circumcision and HIV infection in four cities in sub-Saharan Africa. AIDS. 2001;15 Suppl 4:S31-40. doi:10.1097/00002030-200108004-00004.
  50. Williams BG, Lloyd-Smith JO, Gouws E, et al. The potential impact of male circumcision on HIV in Sub-Saharan Africa. PLoS Med. 2006;3(7):e262. doi:10.1371/journal.pmed.0030262.
  51. Phili R, Abdool-Karim Q, Ngesa O. Low adverse event rates following voluntary medical male circumcision in a high HIV disease burden public sector prevention programme in South Africa. J Int AIDS Soc. 2014;17:19275. doi:10.7448/ias.17.1.19275.
  52. Gray RT, Vallely A, Wilson DP, et al. Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices. PLoS One. 2014;9(8):e104531. doi:10.1371/journal.pone.0104531.
  53. Hatzold K, Mavhu W, Jasi P, et al. Barriers and motivators to voluntary medical male circumcision uptake among different age groups of men in Zimbabwe: results from a mixed methods study. PLoS One. 2014;9(5):e85051. doi:10.1371/journal.pone.0085051.
  54. Starzyk EJ, Kelley MA, Caskey RN, Schwartz A, Kennelly JF, Bailey RC. Infant male circumcision: healthcare provider knowledge and associated factors. PLoS One. 2015;10(1):e0115891. doi:10.1371/journal.pone.0115891.
  55. Fitzgerald L, Benzerga W, Mirira M, et al. Scaling Up Early Infant Male Circumcision: Lessons From the Kingdom of Swaziland. Glob Health Sci Pract. 2016;4 Suppl 1:S76-86. doi:10.9745/GHSP-D-15-00186.
  56. Chilimampunga C, Lijenje S, Sherman J, Nindi K, Mavhu W. Acceptability and feasibility of early infant male circumcision for HIV prevention in Malawi. PLoS One. 2017;12(4):e0175873. doi:10.1371/journal.pone.0175873.
  57. Castellsague X, Bosch FX, Munoz N, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346(15):1105-1112. doi:10.1056/NEJMoa011688.
  58. Siegfried N, Muller M, Deeks J, et al. HIV and male circumcision- -a systematic review with assessment of the quality of studies. Lancet Infect Dis. 2005;5(3):165-173. doi:10.1016/S1473-3099(05)01309-5.
  59. Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006;82(2):101-109; discussion 110. doi:10.1136/sti.2005.017442.
  60. Schoen EJ. The relationship between circumcision and cancer of the penis. CA Cancer J Clin. 1991;41(5):306-309. doi:10.3322/canjclin.41.5.306.
  61. Tsen HF, Morgenstern H, Mack T, Peters RK. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control. 2001;12(3):267-277. doi: 10.1023/A:1011266405062.
  62. Favorito LA, Nardi AC, Ronalsa M, Zequi SC, Sampaio FJ, Glina S. Epidemiologic study on penile cancer in Brazil. Int Braz J Urol. 2008;34(5):587-591; discussion 591-583.
  63. Madsen BS, van den Brule AJ, Jensen HL, Wohlfahrt J, Frisch M. Risk factors for squamous cell carcinoma of the penis--population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. 2008;17(10):2683-2691. doi:10.1158/1055-9965.EPI-08-0456.
  64. Irkilata L, Aydin HR, Aydin M, et al. Preputial bacterial colonisation in uncircumcised male children: Is it related to phimosis? J Pak Med Assoc. 2016;66(3):312-315.
  65. Tang DH, Spiess PE. Should routine neonatal circumcision be a policy to prevent penile cancer? Opinion: No. Int Braz J Urol. 2017;43(1):10-12. doi:10.1590/s1677-5538.ibju.2017.01.04.
  66. Ornellas AA, Ornellas P. Should routine neonatal circumcision be a police to prevent penile cancer? Opinion: Yes. Int Braz J Urol. 2017;43(1):7-9. doi:10.1590/s1677-5538.ibju.2017.01.03.
  67. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000;105(4 Pt 1):789-793. doi:10.1542/peds.105.4.789.
  68. Zorc JJ, Levine DA, Platt SL, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics. 2005;116(3):644-648. doi:10.1542/peds.2004-1825.
  69. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302-308. doi:10.1097/INF.0b013e31815e4122.
  70. Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am. 2001;48(6):1539-1557. doi:10.1016/S0031-3955(05)70390-4.
  71. Frenkl TL, Agarwal S, Caldamone AA. Results of a simplified technique for buried penis repair. J Urol. 2004;171(2 Pt 1):826- 828. doi:10.1097/01.ju.0000107824.72182.95.
  72. Morris BJ, Kennedy SE, Wodak AD, et al. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediatr. 2017;6(1):89-102. doi:10.5409/wjcp.v6.i1.89.
  73. Sorokan ST, Finlay JC, Jefferies AL. Newborn male circumcision. Paediatr Child Health. 2015;20(6):311-320. doi:10.1093/pch/20.6.311.
  74. Jansen M. Routine circumcision of infant boys: It’s time to make progress through the common ground. J Paediatr Child Health. 2016;52(5):477-479. doi:10.1111/jpc.13224.
  75. Abernathy J. The Consequences of Gonorrhea. Lectures on Anatomy, Surgery and Pathology: Including Observations on the nature and treatment of local diseases; delivered at St. Bartholomew’s and Christ’s Hospitals. The Strand, London: James Bulcock; 1828:315-316.
  76. Calendar GW, Willet A. Brief notes of the surgical practice of the Hospital. St Bart’s Hosp Rep. 1865;I:35-62.
  77. Remondino PC. Some reasons for being circumcised. History of Circumcision from Earliest Times to the Present. Philadelphia: Davies Co; 1900:200-205.
  78. Lynch MJ, Pryor JP. Uncircumcision: a one-stage procedure. Br J Urol. 1993;72(2):257-258. doi:10.1111/j.1464-410X.1993.tb00707.x.
  79. Treves F. Circumcision. A Manual of Operative Surgery, II. London: Cassell; 1903:670-673.
  80. Walsham WJ. Circumcision. Surgery, its Theory and Practice. 8th ed. London: Churchill; 1903:1034-1036.
  81. Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int. 1999;83 Suppl 1:1-12. doi:10.1046/j.1464-410x.1999.0830s1001.x.
  82. Doyen E, Spencer-Brown H. Operations on the genito-urinary organs of man. Surgical Therapeutics and Operative Technique III. London: Balliere; 1920:423-428.
  83. Abdulwahab-Ahmed A, Mungadi IA. Techniques of male circumcision. J Surg Tech Case Rep. 2013;5(1):1-7. doi:10.4103/2006-8808.118588.
  84. Miller RL, Snyder DC. Immediate circumcision of the newborn male. Am J Obstet Gynecol. 1953;65(1):1-11. doi:10.1016/0002-9378(53)90002-7.
  85. Kariher DH, Smith TW. Immediate circumcision of the newborn. Obstet Gynecol. 1956;7(1):50-53.
  86. Melges FJ. Newborn circumcision with a new disposable instrument. Obstet Gynecol. 1972;39(3):470-473.
  87. Horowitz M, Gershbein AB. Gomco circumcision: When is it safe? J Pediatr Surg. 2001;36(7):1047-1049. doi:10.1053/jpsu.2001.24739.
  88. Wan J. GOMCO circumcision clamp; an enduring and unexpected success. Urology. 2002;59(5):790-794. doi:10.1016/S0090-4295(01)01320-6
  89. Kankaka EN, Murungi T, Kigozi G, et al. Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda. BJU Int. 2017;119(1):164-170. doi:10.1111/bju.13589.
  90. Peng Y, Masson P, Li PS, et al. No-needle local anesthesia for adult male circumcision. J Urol. 2010;184(3):978-983. doi:10.1016/j.juro.2010.04.080.
  91. Bitega JP, Ngeruka ML, Hategekimana T, Asiimwe A, Binagwaho A. Safety and efficacy of the PrePex device for rapid scale-up of male circumcision for HIV prevention in resource-limited settings. J Acquir Immune Defic Syndr. 2011;58(5):e127-134. doi:10.1097/QAI.0b013e3182354e65.
  92. Morris BJ, Eley C. Male circumcision: An appraisal of current instrumentation. In: Fazel-Rezai R, ed. Biomedical Engineering: From Theory to Applications. Rijeka, Croatia: InTech; 2011:315- 354.
  93. Mutabazi V, Kaplan SA, Rwamasirabo E, et al. HIV prevention: male circumcision comparison between a nonsurgical device to a surgical technique in resource-limited settings: a prospective, randomized, nonmasked trial. J Acquir Immune Defic Syndr. 2012;61(1):49-55. doi:10.1097/QAI.0b013e3182631d69.
  94. Plank RM, Wirth KE, Ndubuka NO, et al. Single-arm evaluation of the AccuCirc device for early infant male circumcision in Botswana. J Acquir Immune Defic Syndr. 2014;66(1):1-6. doi:10.1097/QAI.0000000000000136.
  95. Mangenah C, Mavhu W, Hatzold K, et al. Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe. Glob Health Sci Pract. 2016;4 Suppl 1:S68-75. doi:10.9745/GHSP-D-15-00201.
  96. Nieuwenhuijs JL, Dik P, Klijn AJ, de Jong TP. Y-V plasty of the foreskin as an alternative to circumcision for surgical treatment of phimosis during childhood. J Pediatr Urol. 2007;3(1):45-47. doi:10.1016/j.jpurol.2006.01.011.
  97. Mendez-Gallart R, Estevez E, Bautista A, et al. Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children. J Pediatr Surg. 2009;44(10):2048-2053. doi:10.1016/j.jpedsurg.2009.06.008.
  98. Harty NJ, Nelson CP, Cendron M, Turner S, Borer JG. The impact of electrocautery method on post-operative bleeding complications after non-newborn circumcision and revision circumcision. J Pediatr Urol. 2013;9(5):634-637. doi:10.1016/j.jpurol.2012.06.019.
  99. Karaman MI, Zulfikar B, Ozturk MI, Koca O, Akyuz M, Bezgal F. Circumcision in bleeding disorders: improvement of our cost effective method with diathermic knife. Urol J. 2014;11(2):1406- 1410.
  100. Van Haute C, Tailly T, Klockaerts K, Ringoir Y. Sutureless circumcision using 2-Octyl cyanoacrylate results in more rapid and less painful procedures with excellent cosmetic satisfaction. J Pediatr Urol. 2015;11(3):147.e141-145. doi:10.1016/j.jpurol.2015.02.013.
  101. Williams N, Kapila L. Complications of circumcision. Br J Surg. 1993;80(10):1231-1236. doi:10.1002/bjs.1800801005.
  102. Gerharz EW, Haarmann C. The first cut is the deepest? Medicolegal aspects of male circumcision. BJU Int. 2000;86(3):332-338. doi:10.1046/j.1464-410x.2000.00103.x.
  103. Stefan H. Reconstruction of the penis after necrosis due to circumcision burn. Eur J Pediatr Surg. 1994;4(1):40-43. doi:10.1055/s-2008-1066064.
  104. Seleim HM, Elbarbary MM. Major penile injuries as a result of cautery during newborn circumcision. J Pediatr Surg. 2016;51(9):1532-1537. doi:10.1016/j.jpedsurg.2016.04.014.
  105. Maccarthy D, Douglas JW, Mogford C. Circumcision in a national sample of 4-year-old children. Br Med J. 1952;2(4787):755-756. doi:10.1136/bmj.2.4787.755.
  106. 106. Leitch IO. Circumcision. A continuing enigma. Aust Paediatr J. 1970;6(2):59-65.
  107. Fraser IA, Allen MJ, Bagshaw PF, Johnstone M. A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique. Br J Surg. 1981;68(8):593-595. doi:10.1002/bjs.1800680822.
  108. Byars LT, Trier WC. Some complications of circumcision and their surgical repair. AMA Arch Surg. 1958;76(3):477-482. doi:10.1001/archsurg.1958.01280210147033.
  109. Kaplan GW. Complications of circumcision. Urol Clin North Am. 1983;10(3):543-549.
  110. Smey P. Re: Penile denudation injuries after circumcision. J Urol. 1985;134(6):1220. doi:10.1016/S0022-5347(17)47697-X.
  111. Upadhyay V, Hammodat HM, Pease PW. Post circumcision meatal stenosis: 12 years’ experience. N Z Med J. 1998;111(1060):57-58.
  112. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA. Newborn penile glans amputation during circumcision and successful reattachment. J Urol. 1995;153(3 Pt 1):778-779. doi:10.1016/S0022-5347(01)67718-8.
  113. Edler G, Axelsson I, Barker GM, Lie S, Naumburg E. Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure. Acta Paediatr. 2016;105(7):842-850. doi:10.1111/apa.13402.
International Journal of Medical Reviews
Volume 5, Issue 1
March 2018
Pages 6-18

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History

  • Receive Date: 19 January 2018
  • Revise Date: 01 March 2018
  • Accept Date: 02 March 2018

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