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CPS Fetus and Newborn > Newborn Male Circumcision > Flashcards

Newborn Male Circumcision Flashcards

1
Q

What are the historical medical benefits of male circumcision?

A
  • Ease of genital hygiene
  • Diminished risk of disease
  • Avoidance of circumcision later in life
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2
Q

What is the current Canadian average rate of circumcision?

A

32%

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3
Q

What is the usual developmental pattern of retractile foreskin?

A
  • In newborns: inner foreskin and glans adhere to one another
  • 6 years of age: 50% boys can retract their foreskin
  • 17 years of age: 95% boys can retract their foreskin
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4
Q

What are the potential benefits of circumcision?

A
  • Phimosis treatment
  • UTI reduction
  • STI reduction
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5
Q

Define phimosis

A
  • Scarring and thickening of the foreskin that prevents retraction back over the glans
  • Secondary to recurrent infections, inflammation or lichen sclerosis
  • Not the same as normal nonretractile foreskin
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6
Q

Define posthitis and balanoposthitis

A
  • Posthitis: inflammation or infection of the foreskin
  • Balanoposthitis: inflammation or infection of the foreskin in association with the glans
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7
Q

What is the incidence of posthitis and balanoposthitis in uncircumcised boys?

A
  • 1-4%
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8
Q

What is the definition and incidence of paraphimosis?

A
  • Definition: foreskin becomes trapped behind the glans
  • Incidence: 0.5%
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9
Q

What percentage of boys will need cicrumcision befoer puberty and what is the most common indication for the same?

A
  • 0.8-1.6%
  • Indicated for treatment of phimosis
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10
Q

What is the first line medical treatment for phimosis?

A
  • Application of a topical steroid BID to the foreskin with gentle traction
  • Serves to thin skin and release adhesions
  • Foreskin becomes retractile in 80% with no need for circumcision
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11
Q

What steroid preparations have been used to treat phimosis?

A
  • Betamethasone 0.05-0.1%
  • Triamcinolone 0.1%
  • Mometasone furoate 0.1%
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12
Q

What role does the preputial sac play in UTI development in male infants?

A
  • Provides an environment for colonization of the urethra with uropathogenic organisms
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13
Q

What is the incidence of UTI in male infants in the first month of age?

A

1%

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14
Q

What impact does circumcision have on UTI?

A
  • 90% reduction in UTI in circumcised male infants
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15
Q

Compare prevalence of UTI in febrile infants < 3 months of age

A
  • Females 7.5%
  • Circumcised males: 2.4%
  • Uncircumcised males: 20.1%
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16
Q

What is the NNT with circumcision to prevent one UTI?

A

111-125 normal infant boys would need to be circumcised at birth to prevent one UTI

17
Q

What is the NNTto prevent one UTI for males with recurrent UTI or underlying GU anomalies?

A

4 boys would need to be circumcised to prevent one UTI

18
Q

What is a confounding factor leading to overdiagnosis of UTI in uncircumcised males?

A
  • Contaminated urine samples are more common in uncircumcised boys
  • Therefore NNT can be considerably higher in reality than current estimates
19
Q

What percentage of UTI leads to DMSA-detectable renal scarring?

A

15%

20
Q

What is the long term impact of renal scarring?

A
  • Theoretically scarring could have an impact on long term renal function and cause HTN
  • No evidence for this association
  • Most experts believe UTIs in children with normal kidneys do not result in long term sequelae
21
Q

Why could uncircumcised men be at higher risk for HIV?

A
  • Inner surface of foreskin rich in Langerhans and other HIV target cells which are exposed to infection during intercourse
22
Q

What is the evidence that circumcision decreases HIV transmission?

A
  • 3 large RCTs involving men and teen boys in Uganda, South Africa and Kenya
  • Decrease in new HIV infection by 50-60% in circumcised male participants
  • Unclear if these conclusions hold true in other populations with lower HIV seroprevalence and where HIV is more likely to be contracted via IVDU and MSM
23
Q

What were the results of the CDC analysis of cost efficacy of newborn circumcision in reducing the lifetime risk of HIV?

A
  • Cost savings in both Hispanic and Black males
  • NNT to prevent one HIV infection in white males is 1231
  • NNT to prevent one HIV infection in black males is 65
  • Average NNT = 298
  • Model did not account for cost of complications in circumcision
  • RIsk of men overestimating protective effect of circumcision and not using safe sex practices
24
Q

What are new cases of HIV attributed to in Canada?

A
  • 46% MSM
  • 13.7% IVDU
  • Heterosexual transmission 20.3%
25
Q

Compare HIV transmission in aboriginal compared to non aboriginal populations

A

Rate of new cases in aboriginal population is 3.5 times higher than non aboriginal population

26
Q

What effect does circumcision have on other STIs besides HIV?

A
  • Lower rates of HSV-2 seroconversion
  • Lower rates of HPV acquisition
  • Not protective against gonorrhea or chlamydia
  • Female partners of circumcised men with lower prevalence of
    • Trichomonas (0.52)
    • Bacterial vaginosis (0.60)
    • Genital ulcer disease (0.78)
27
Q

What is the cervical cancer risk in female partners of circumcised men?

A

Reduced with ORs ranging from 0.18-1.61 depending on the sexual behavioural risk level of their partner

28
Q

What is the incidence of cervical cancer in Canada?

A

9-17/100,000

29
Q

What is the incidence of penile cancer in develoepd countries?

A

1/100,000

30
Q

What is the strongest associated RF for squamous cell carcinoma of the penis?

A
  • Phimosis
  • OR 11.4
  • Underscores importance of genital hygiene and of identifying and treating cases of phimosis and residual nonretractile foreskin in all males
  • Also a strong association between HPV infection and penile cancer regardless of circumcision status
31
Q

List potential risks of circumcision

A
  • Procedural pain - altered response to later vaccinations with higher demonstrated pain scores
  • Minor bleeding
  • Local infection
  • Unsatisfactory cosmetic outcome
32
Q

List severe complications of circumcision

A
  • Partial amputation of the penis
  • Death from hemorrhage or sepsis
33
Q

What is the median complication rate for circumcision in infants and older children?

A
  • Neonates/infants: 1.5%
  • Childhood: 6%
34
Q

What is the most common late complication of circumcision?

A
  • Meatal stenosis
  • 2-10%
  • May require surgical dilation
35
Q

How to prevent meatal stenosis?

A
  • Applying petroleum jelly to the glans for up to 6 months following circumcision
  • Partial re-adherence of penile skin to glans is common, usually resolves spontaneously by puberty but can also benefit from topical steroids
36
Q

What is the effect of circumcision on sexual function or satisfaction?

A
  • No negative impact on sexual function or satisfaction
    • Some literature reports males not happy with cosmesis but no specific data to quantify this
37
Q

What are the containdications to circumcision?

A
  • Hypospadias
  • Bleeding diathesis
38
Q
A

CPS Fetus and Newborn (7 decks)

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