Newborn Male Circumcision Flashcards
What is the rate of circumcision in Canada at present?
32%
When would you expect the foreskin to separate?
The foreskin separates gradually.
by 6 years - 50% of boys can retract the foreskin
By 17 year - 97 % of boys can retract foreskin
What are the symptoms of a nonretractile foreskin?
poor urinary stream
What is circumcision?
partial or complete removal of the foreskin
What is phimosis?
Scarring and thickening of the foreskin that prevents retraction back over the glans
Why does phimosis occur?
3
recurrent infections
inflammation
lichen sclerosis
What is posthitis and how do you treat it?
It is the inflammation of the foreskin, frequently associated with inflammation of the glans (balanoposthitis).
Both conditions resolve with medical therapy: topical steroids BID to the foreskin with gentle traction.
➡️ thins the tissue and release the adhesions
How effective is medical treatment of posthitis?
works in 80%
Is there anything you can do to hasten retraction of non-retractile foreskin?
you can use the topical steroid
Why do uncircumcised kiddos get UTIs?
because the preputial sac provides an environment for colonization of the urethra with uropathogenic organsism that can cause UTIs
How frequently does a UTI cause renal scarring?
Is this important?
15%
No current evidence that these renal scars cause HTN and renal impairment
Why are uncircumcised kids at a higher risk of HIV
theory: the inner surface of the foreskin is rich in Langerhans and other HIV target cells
Does circumcision lower risk of HIV?
unclear. There are studies in the developing world that show a decreased risk in circumcised males in heterosexual sex. It is unclear though if these finings can be applied to the developed countries where routes of transmission are MSM (46%) and IVDU (13%)
Does circumcision decrease the risk of male to female transmission of HIV?
No evidence. The only evidence is for female to male transmission
Is circumcision protective against Gonorrhea or chlamydia
No
What STIs is circumcision potentially protective against?
HPV
HSV 2
Trichomonas vaginalis, BV and ulcer
Although all evidence is controvercial
Are there any cancers that are decreased with circumcision?
Squamous cell carcinoma only occurs in uncircumcised men (especially with phimosis)
Maybe a reduced risk of cervical cancer, but hard to know how the HPV vaccination will affect this
What are the risks of circumcision?
Pain –> ? long term changes to pain response
minor bleeding
local infection
cosmetic stuff
severe: partial amputation, death from haemorrhage or sepsis
Late: meatal stenosis and adhesives (rarely need steroids or surgery)
What is the complication rate of circumcision
In neonates: 1.5%
Childhood: 6%
Can you prevent meatal stenosis as a late complication?
Yes by applying petroleum jelly to the glans x 6 months
Is there a negative impact on sexual function with circumcision?
no evidence
the foreskin has an abundance of sensory nerves
Is there anyone who should NOT get a circumcision
hypospadias
bleeding diathesis
Which kids get circumcised later in life?
Phimosis
paraphimosis
balanoposthitis
Should all kids be circumcised
no.
need to consider pros and cons for each individual kid
