Di-san junyi daxue xuebao (Jul 2020)
Common causes and treatment strategies for circumcision-related glans amputation
Abstract
Objective To discuss the common causes and treatment strategies of circumcision-related glans amputation. Methods A 7-year-old boy underwent circumcision at a local hospital using a disposable circumcision stapler, during which complete severing of the glans penis and the frenulum occurred due to surgical error. The boy was immediately transferred to our hospital with the amputated tissue preserved in iced saline. Emergency surgical exploration confirmed that about 1/3 of the glans tissue and its ventral frenulum at the distal end of the coronary sulcus were completely severed by a guillotine-type cut. We then performed microscopic repair of the severed glans with glans replantation and end-to-end urethrostomy. Based on our experience with treatment of glans amputation caused by a circumcision stapler and review of the literature, we discuss the common causes and treatment methods of circumcision-related glans amputation. Results The child recovered well after the surgery with normal morphology of the glans and normal urinary function. No ureteral stricture or urinary fistula occurred after the surgery, and the boy's erectile function was normal. Literature review showed that amputation of the glans caused by circumcision instrument occurs much more frequently than that caused by manual operation. The most common treatment in stage I is glans replantation (54.3%) and urethra end-to-end anastomosis (31.4%), and glans reconstruction is the most common stage Ⅱ treatment (44.4%). Conclusion Improper operation of equipment is the main cause of circumcision-related glans amputation. The ideal early treatment is microscopic replantation of the glans and end-to-end urethrostomy as early as possible. If the opportunity of early replantation is lost, various techniques such as reconstruction of glans can be used to restore the appearance of the glans and normal urinary function.
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