Outcome of circumcision for newborns with penoscrotal web: oblique skin incision followed by penis shaft skin physical therapy shows success

Max Maizels*, P. Meade, I. Rosoklija, M. Mitchell, Dennis B Liu

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Short Introduction/Background: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. Objective: With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. Study Design: Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the ‘normal’ group if they had no penile anomalies or the ‘web’ group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as ‘push down’ the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. Results: Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. Discussion: It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. Conclusion: It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Penis
Newborn Infant
Skin
Scrotum
Therapeutics
Hypospadias
Urology
Home Care Services
Checklist
Anatomy

Keywords

  • Circumcision
  • Newborn circumcision
  • Oblique incision
  • Penoscrotal web

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

@article{3d5bca03831f4353afc1ca46cd6750f2,
title = "Outcome of circumcision for newborns with penoscrotal web: oblique skin incision followed by penis shaft skin physical therapy shows success",
abstract = "Short Introduction/Background: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. Objective: With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. Study Design: Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the ‘normal’ group if they had no penile anomalies or the ‘web’ group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as ‘push down’ the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. Results: Of 828 boys who presented for circumcision, 652 (79{\%}) were enrolled as they were suitable for circumcision: 355 (43{\%}) in the normal group and 297 (36{\%}) in the web group. The remaining 176 (21{\%}) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89{\%}) cases, with 261 of 263 (99{\%}) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92{\%}) cases, with all 327 (100{\%}) showing success. The two web group cases (0.7{\%}) who failed had surgical reconstruction. Discussion: It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. Conclusion: It was found that newborns with a penoscrotal web and straight shaft show 99{\%} success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.",
keywords = "Circumcision, Newborn circumcision, Oblique incision, Penoscrotal web",
author = "Max Maizels and P. Meade and I. Rosoklija and M. Mitchell and Liu, {Dennis B}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jpurol.2019.05.021",
language = "English (US)",
journal = "Journal of Pediatric Urology",
issn = "1477-5131",
publisher = "Elsevier BV",

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TY - JOUR

T1 - Outcome of circumcision for newborns with penoscrotal web

T2 - oblique skin incision followed by penis shaft skin physical therapy shows success

AU - Maizels, Max

AU - Meade, P.

AU - Rosoklija, I.

AU - Mitchell, M.

AU - Liu, Dennis B

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Short Introduction/Background: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. Objective: With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. Study Design: Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the ‘normal’ group if they had no penile anomalies or the ‘web’ group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as ‘push down’ the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. Results: Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. Discussion: It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. Conclusion: It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.

AB - Short Introduction/Background: and objectives: Although it is widely agreed that newborn circumcision complications are low when the penile anatomy is normal, outcomes are uncertain when a web of skin attaches the penis to the scrotum. This anomaly, called a penoscrotal web or webbed penis, often leads to surgical reconstruction instead of newborn circumcision. Objective: With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. Study Design: Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the ‘normal’ group if they had no penile anomalies or the ‘web’ group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as ‘push down’ the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. Results: Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. Discussion: It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. Conclusion: It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p = not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.

KW - Circumcision

KW - Newborn circumcision

KW - Oblique incision

KW - Penoscrotal web

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