Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital, Hvidovre, Capital Region of Denmark.
Mental Health Services, Capital Region of Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Capital Region of Denmark.
Urology. 2021 Jun;152:25-34. doi: 10.1016/j.urology.2021.01.041. Epub 2021 Feb 2.
To determine the risk of complications requiring treatment following male circumcision by health-care professionals and to explore the impact of participant characteristics, type of circumcision and study design.
We identified studies through systematic searches in online databases (MEDLINE, EMBASE and CENTRAL) and hand searches. We performed random-effects meta-analysis to determine risk of circumcision complications and mixed-effects metaregression analyses to explore the impact of participant characteristics, type of circumcision and study design. Methods were prespecified in a registered protocol (Prospero CRD42020116770) and according to PRISMA guidelines.
We included 351 studies with 4.042.988 participants. Overall complication risk was 3.84% (95% confidence interval 3.35-4.37). Our meta-analysis revealed that therapeutic circumcisions were associated with a 2-fold increase in complications as compared to nontherapeutic (7.47% and 3.34%, respectively). Adhesions, meatal stenosis and infections were the most frequent complication subgroups to therapeutic circumcisions. Bleeding, device removals and infections occurred more frequently in nontherapeutic circumcisions. Additionally, adjusted metaregression analyses revealed that children above 2 years, South American continent, older publication year and smaller study populations increased complication risk. Type of circumcision method, provider and setting were not associated with complication risk. Sensitivity analyses including only better-quality studies reporting indication, age at circumcision, treatment for complications, full-text articles, and adequate follow-up clinically for a minimum of one month or through databases confirmed our main findings while accounting better for heterogeneity.
Circumcision complications occur in about 4 per hundred circumcisions. Higher risks of complications were determined by therapeutic circumcisions and by childhood age when compared to infant. Future studies should assess therapeutic and childhood circumcisions separately.
确定医疗保健专业人员进行男性割礼后需要治疗的并发症风险，并探讨参与者特征、割礼类型和研究设计的影响。
我们通过在线数据库（MEDLINE、EMBASE 和 CENTRAL）和手工检索来确定研究。我们进行了随机效应荟萃分析，以确定割礼并发症的风险，并进行了混合效应荟萃回归分析，以探讨参与者特征、割礼类型和研究设计的影响。方法在预先注册的方案（PROSPERO CRD42020116770）和根据 PRISMA 指南中进行了规定。
我们纳入了 351 项研究，涉及 4042988 名参与者。总体并发症风险为 3.84%（95%置信区间 3.35-4.37）。我们的荟萃分析表明，与非治疗性割礼相比，治疗性割礼的并发症风险增加了 2 倍（分别为 7.47%和 3.34%）。粘连、尿道口狭窄和感染是治疗性割礼最常见的并发症亚组。非治疗性割礼中更常发生出血、器械移除和感染。此外，调整后的荟萃回归分析表明，2 岁以上的儿童、南美洲大陆、较旧的出版年份和较小的研究人群增加了并发症风险。割礼方法、提供者和环境类型与并发症风险无关。敏感性分析包括仅报告适应证、割礼年龄、并发症治疗、全文文章和至少通过数据库进行一个月或更长时间的临床随访的高质量研究，这些研究确认了我们的主要发现，同时更好地解释了异质性。
割礼并发症每 100 例中发生约 4 例。与婴儿相比，治疗性割礼和儿童时期的风险更高。未来的研究应分别评估治疗性和儿童割礼。
