Appiah Boakye Sylvester, Obeng Frank
School of Medicine, University of Health and Allied Sciences, Ho, Ghana.
Department of Surgery, Urology Unit, University of Health and Allied Sciences, Ho, Ghana.
PLOS Glob Public Health. 2025 Feb 3;5(2):e0003788. doi: 10.1371/journal.pgph.0003788. eCollection 2025.
Male circumcision is increasing in popularity due to its medical benefits, including reducing HIV prevalence. It is commonly performed by both health and non-health professionals, with most circumcisions occurring during the neonatal period. Studies suggest the benefits outweigh the risks, though complications can occur. This study aimed to determine the clinical outcomes of circumcisions and the prevalence of adverse events of circumcision in the Volta region of Ghana. A five-year retrospective descriptive and analytic study was conducted at Ho Teaching Hospital, using a structured data extraction sheet to collect demographic, clinical, and circumcision-related data from 186 cases. Among 186 circumcision cases, 23 (12.37%) experienced complications, with the most common being partial circumcision (43.48%), post-circumcision bleeding (21.74%), and urethrocutaneous fistula and/or wrongfully circumcised congenital hypospadias (13.04%). Low heamoglobin levels and infections were also noted. A significant relationship was found between the circumcision provider and complication rates (Chi-square = 16.975, p = 0.00). Doctors conducting circumcision had the lowest complication rates (4.3%), while nurses and traditional circumcisers had higher complication rates (39.1% and 34.8%, respectively). Circumcision-Revision surgery was the most common salvage surgery for circumcision mishaps (31.82%), with urethroplasty and hypospadias repair (for wrongful circumcised neonates born with hypospadias) accounting for 15.91%. Meatoplasties, glansplasties, fistulectomy plus primary repair and chordae-release surgeries were also performed. The success rate for salvage surgeries (first attempt) was 70%. Prompt initial management strategies were significantly associated with good outcomes. Under less-trained hands, circumcision could be catastrophic. Salvage surgeries for circumcision mishaps are associated with less favourable outcomes in about one-third of the cases, suggesting that circumcision mishaps are better prevented than salvaged. Training, guidance, and policy interventions are needed to reduce the incidence of circumcision-related mishaps. Public health campaigns to dissuade non-surgeon circumcisers to refrain from circumcising children with hypospadias but refer them, are urgently needed.
由于其医学益处，包括降低艾滋病毒感染率，男性包皮环切术越来越受欢迎。健康专业人员和非健康专业人员都普遍进行包皮环切术，大多数包皮环切术在新生儿期进行。研究表明，益处大于风险，不过也可能出现并发症。本研究旨在确定加纳沃尔特地区包皮环切术的临床结果以及包皮环切术不良事件的发生率。在霍教学医院进行了一项为期五年的回顾性描述性和分析性研究，使用结构化数据提取表从186例病例中收集人口统计学、临床和包皮环切术相关数据。在186例包皮环切术病例中，23例（12.37%）出现并发症，最常见的是部分包皮环切术（43.48%）、包皮环切术后出血（21.74%）以及尿道皮肤瘘和/或先天性尿道下裂误切（13.04%）。还发现了低血红蛋白水平和感染情况。包皮环切术实施者与并发症发生率之间存在显著关系（卡方 = 16.975，p = 0.00）。实施包皮环切术的医生并发症发生率最低（4.3%），而护士和传统包皮环切师的并发症发生率较高（分别为39.1%和34.8%）。包皮环切修复手术是包皮环切术失误最常见的补救手术（31.82%），尿道成形术和尿道下裂修复术（针对出生时患有尿道下裂的误切新生儿）占15.91%。还进行了尿道口成形术、龟头成形术、瘘管切除术加一期修复术和弦索松解手术。补救手术（首次尝试）的成功率为70%。及时的初始处理策略与良好结果显著相关。在经验不足的人手中，包皮环切术可能会带来灾难性后果。包皮环切术失误的补救手术在约三分之一的病例中效果不佳，这表明包皮环切术失误预防比补救更好。需要进行培训、指导和政策干预以降低包皮环切术相关失误的发生率。迫切需要开展公共卫生运动，劝阻非外科包皮环切师不要为患有尿道下裂的儿童进行包皮环切术，而是将他们转诊。
