A Systematic Review of Urethral Complications Following Male Circumcision: The Importance of Provider Training

Abstract

Background: Male circumcision is one of the most common elective surgical procedures worldwide. Adverse events affecting the urethra may occur following the procedure. Aim: The aim of this paper is to provide a review of the existing literature on urethral complications of male circumcision. Materials and Methods: A search of PubMed and Google Scholar was conducted between November 20, 2020, and November 30, 2020 and updated on January 12, 2021. Several keywords related to male circumcision were searched on the two databases. Afurther manual search of the reference lists of relevant papers was carried out. Studies that reported frequencies of urethral complications following circumcision were included in the analysis. A total of 83 candidate papers were identified and studied before arriving at 38 studies that contained sufficient information suitable for the analysis. Results: Overall, we found that the reported frequencies of urethral complications of male circumcision varied (range 0.01% to 39%; median 1.7%). Meatal stenosis (MS) and urethrocutaneous fistula (UCF) were by far the most frequently reported urethral complications of male circumcision with cases reported in 30 and 18 studies, respectively. Meatitis and urethral stricture were the other urethral complications found in our search. Conclusion: The urethral complications of male circumcision we found were UCF, MS, meatitis/meatal ulcer, and urethral stricture. Neonatal circumcision and circumcision by untrained providers are associated with higher incidences of urethral tragedies following male circumcision. The type of male circumcision provider is also a determinant of the frequency of complications.