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The Surgery: Infant Circumcision

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Published on Oct 4, 2010

The foreskin is separated from the glans. To do this, a dorsal slit in the foreskin is frequently employed. The bell of the Gomco clamp is placed over the glans, and the foreskin is pulled over the bell. The base of the Gomco clamp is placed over the bell, and the Gomco clamp's arm is fitted. After the surgeon confirms correct fitting and placement (and the amount of foreskin to be excised), the nut on the Gomco clamp is tightened, causing the clamping of nerves and blood flow to the foreskin. The Gomco clamp is left in place for about five minutes to allow clotting to occur, then the foreskin is severed using a scalpel. The Gomco's base and bell are then removed, allowing for bandaging of the penis.

Gomco stands for the GOldstein Medical COmpany and invented the Gomco clamp on the earlier successes of the Yellen clamp.

Urinary tract infections

A meta-analysis of 12 studies (one randomised controlled trial, four cohort studies and seven case-control studies) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of urinary tract infection (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade vesicoureteral reflux or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).

Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. The AMA stated that depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.

Penile cancer

The American Cancer Society (2006) stated, "The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer."

The American Academy of Pediatrics stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.

The age-adjusted annual incidence of penile cancer is 0.82 per 100,000 in Denmark, 2.9-6.8 per 100,000 in Brazil, 0.9 to 1 per 100,000 in the USA, and 2.0-10.5 per 100,000 in India. Researchers have reported that the risk of penile cancer is greater in never-circumcised men than in men who had been circumcised at birth; estimates of the relative risk include 3 and 22.

Sexually transmitted infections

Studies evaluating the ability of circumcision to reduce the incidence of other sexually transmitted infections have reached conflicting conclusions. A meta-analysis of observational data from twenty-six studies found that circumcision was associated with lower rates of syphilis, chancroid and possibly genital herpes. A large randomized prospective trial in Uganda found a reduction in HSV-2 infection, but not syphilis infection, in the circumcision arm of the study. In contrast, other studies have failed to find a prophylactic benefit to circumcision. A prospective trial in India found that circumcision offered no protective benefit against herpes simplex virus type 2, syphilis, or gonorrhea. A clinical study of 5,925 women from Uganda, Zimbabwe and Thailand found that the circumcision status of their partner did not significantly affect the incidence of Chlamydia, gonorrhea or trichomoniasis. Laumann et al. examined observational data from the United States and found no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.

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