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COMPLICATIONS OF CIRCUMCISION*
 

  Immediate complications of this surgical operation include:
  • hemorrhage, sometimes to the point of death or requiring a transfusion;1-10
  • minor infections;11-14
  • life-threatening infections such as
    • sepsis,15-17
    • meningitis,18-19
    • gangrene,20-28
    • staphylococcal scalded skin syndrome,29-30
    • erysipelas,31
    • and scrotal abscess;32-33
  • acute urinary retention leading to renal failure;34-38
  • penile ischemia;39
  • necrosis;40-45
  • buried penis;46-57
  • partial or complete penile amputation;58-74
  • iatrogenic hypospadias;75
  • total denudation of the penis;76-83
  • abdominal distension;84
  • pneumothorax;85
  • plastibell retention;86-91
  • urethral fistula;92-100
  • meatal ulceration;101-102
  • keloid formation;103-105
  • ruptured bladder;106
  • gastric rupture;107
  • tachycardia and heart failure;108
  • myocardial injury;109
  • iatrogenic burns;110-111
  • pulmonary embolism;112
  • phimosis;113-115
  • unilateral leg cyanosis;116
  • and death.117-120

Of the studies on circumcision complications published to date, all but one have been retrospective, which would tend to underestimate the true incidence of complications. Reported retrospective complication rates have included 2.0%,121 3.1%,122 and 6.4%.123 The only prospective study documented hemorrhage following 9.9% of circumcisions.124 No other complications were investigated in that study.

Topical anesthesia carries the risk of methemoglobinemia.125-128 Local anesthesia does not ameliorate post-operative pain as the baby voids and defecates into an open wound.129

Once home from the hospital, the baby faces an increased risk of penile130 and other skin infections,131-133 inflammation of the meatus, meatal stenosis,134-149 coronal adhesions,150-153 and skin bridges.154-156
 
Courtesy R. S. Van Howe, MD, Marshfield Clinic, Minocqua, Wisconsin, USA.



1. Awidi AS. Delivery of infants with Glanzmann thrombasthenia and subsequent blood transfusion requirements: a follow-up of 39 patients. Am J Hematol 1992; 40: 1-4.

2. Steinau G, Tittel A, Schumpelick V. Tageschirurgische (TCH) Eingriffe im Kindesalter an einer chirurgischen Klinik. [Ambulatory surgery interventions in childhood in a surgical clinic] Zentralbl Chir 1993; 118: 25-9.

3. Watts RW, Stokes PA. Secondary arterial haemorrhage following circumcision; an unusual cause of antepartum haemorrhage. Aust N Z J Obstet Gynaecol 1986; 26: 312-3.

4. Denton J, Schreiner RL, Pearson J. Circumcision complication. Reaction to treatment of local hemorrhage with topical epinephrine in high concentration. Clin Pediatr Phila 1978; 17: 285-6;

5. Poll JS, Prinsen JE. Niet-geplande opname na dagverpleging bij kinderen. [Unplanned hospitalization following day surgery in children] Ned Tijdschr Geneeskd 1990; 134: 1089-91.

6. Cyran W. Aus der Praxis einer Gutachterstelle: Schwere Nachblutung nach einer Phimosenoperation. [From general practice of an expert assessment service: severe hemorrhage after surgery for phimosis] Z Arztl Fortbild Jena 1994; 88: 703-4.

7. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976; 58: 824-7.

8. Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 1989; 83: 1011-5.

9. Tsang TM, Tam PK. Complications of circumcision. Br J Surg 1994; 81: 473.

10. Willson. Cesarean section for threatened eclampsia and death of the child following circumcision. Am J Obstetr 1913; 68: 351-5.

11. Stranko J, Ryan ME, Bowman AM. Impetigo in newborn infants associated with a plastic bell clamp circumcision. Pediatr Infect Dis 1986; 5: 597-9.

12. Zafar AB, Butler RC, Reese DJ, Gaydos LA, Mennonna PA. Use of 0.3% triclosan (Bacti Stat) to eradicate an outbreak of methicillin resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 1995; 23: 200-8.

13. Nelson JD, Dillon HC Jr, Howard JB. A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus. J Pediatr 1976; 89: 792-6.

14. Wiswell TE, Curtis J, Dobek AS, Zierdt CH. Staphylococcus aureus colonization after neonatal circumcision in relation to device used. J Pediatr 1991; 119: 302-4.

15. Kirkpatrick BV, Eitzman DV. Neonatal septicemia after circumcision. Clin Pediatr Phila 1974; 13: 767-8.

16. Braun D. Neonatal bacteremia and circumcision. Pediatrics 1990; 85: 135-6.

17. Southby R, Myers N. A case against circumcision. Med J Austr 1965; 2: 393.

18. Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. Isr J Med Sci 1981; 17: 45-8.

19. Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision. Med J Aust 1977; 1: 332-4.

20. du Toit DF, Villet WT. Gangrene of the penis after circumcision: a report of 3 cases. S Afr Med J 1979; 55: 521-2.

21. Sussman SJ, Schiller RP, Shashikumar VL. Fournier's syndrome. Report of three cases and review of the literature. Am J Dis Child 1978; 132: 1189-91.

22. Evbuomwan I, Aliu AS. Acute gangrene of the scrotum in a one month old child. Trop Geogr Med 1984; 36: 299-300.

23. Adeyokunnu AA. Fournier's syndrome in infants. A review of cases from Ibadan, Nigeria. Clin Pediatr Phila 1983; 22: 101-3.

24. Hamm WG, Kanthak FF. Gangrene of the penis following circumcision with high frequency current. South Med J 1949; 42: 657-9.

25. Thorek P, Egel P. Reconstruction of the penis with split-thickness skin graft: a case of gangrene following circumcision for acute balanitis. Plast Reconst Surg 1949; 4: 469-72.

26. Ahmed S, Shetty SD, Anandan N, Patil KP, Ibrahim AIA. Penile reconstruction following post-circumcision penile gangrene. Pediatr Surg Int 1994; 9: 295-6.

27. Kurel S. Iatrogenic penile gangrene: 10-year follow-up. Plast Reconst Surg 1995; 95: 210-1.

28. Pinkham EW Jr, Stevenson AW Jr. Unusual reaction to local anesthesia: gangrene of the prepuce. US Armed Forces Med J 1958; 9: 120-2.

29. Anday EK, Kobori J. Staphylococcal scalded skin syndrome: a complication of circumcision. Clin Pediatr Phila 1982; 21: 420.

30. Annunziato D, Goldblum LM. Staphylococcal scalded skin syndrome. A complication of circumcision. Am J Dis Child 1978; 132: 1187-8.

31. Shah BR, Santucci K, Tunnessen WW. Clinical picture. Arch Fam Med 1995; 4: 670-1.

32. Uwyyed K, Korman SH, Bar Oz B, Vromen A. Scrotal abscess with bacteremia caused by Salmonella group D after ritual circumcision. Pediatr Infect Dis J 1990; 9: 65-6.

33. Dinari G, Haimov H, Geiffman M. Umbilical arteritis and phlebitis with scrotal abscess and peritonitis. J Pediatr Surg 1971; 6: 176.

34. Craig JC, Grigor WG, Knight JF. Acute obstructive uropathy--a rare complication of circumcision. Eur J Pediatr 1994; 153: 369-71.

35. Eason JD, McDonnell M, Clark G. Male ritual circumcision resulting in acute renal failure. Br Med J 1994; 309: 660-1.

36. Ochsner MG. Acute urinary retention: causes and treatment. Postgrad Med 1982; 71: 221-6.

37. Berman W. Letter: Urinary retention due to ritual circumcision. Pediatrics 1975; 56: 621.

38. Frand M, Berant N, Brand N, Rotem Y. Complication of ritual circumcision in Israel. Pediatrics 1974; 54: 521.

39. Smith DJ, Hamdy FC, Chapple CR. An uncommon complication of circumcision. Br J Urol 1994; 73: 459-60.

40. Stefan H. Reconstruction of the penis after necrosis due to circumcision burn. Eur J Pediatr Surg 1994; 4: 40-3.

41. Stefan H. Reconstruction of the penis following necrosis from circumcision used high frequency cutting current. Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove Suppl 1992; 35: 449-54.

42. Rosefsky JB Jr. Glans necrosis as a complication of circumcision. Pediatrics 1967; 39: 774-6.

43. Woodside JR. Necrotizing fasciitis after neonatal circumcision. Am J Dis Child 1980; 134: 301-2.

44. Sterenberg N, Golan J, Ben-Hur N. Necrosis of the glans penis following neonatal circumcision. Plast Reconstr Surg 1981; 68: 237-9.

45. Woodside JR. How to lessen risk of wound infection after circumcision. Mod Med 1980; 48(16): 93.

46. Bergeson PS, Hopkin RJ, Bailey RB Jr, McGill LC, Piatt JP. The inconspicuous penis. Pediatrics 1993; 92:794-9.

47. van-der Zee JA, Hage JJ, Groen JM, Bouman FG. Een ernstige complicatie ten gevolge van rituele circumcisie van een 'begraven' penis. [A serious complication of ritual circumcision of a 'buried' penis] Ned Tijdschr Geneeskd 1991; 135: 1604-6.

48. Radhakrishnan J, Reyes HM. Penoplasty for buried penis secondary to "radical" circumcision. J Pediatr Surg 1984; 19: 629-31.

49. Kon M. A rare complication following circumcision: the concealed penis. J Urol 1983; 130: 573-4.

50. Talarico RD, Jasaitis JE. Concealed penis: a complication of neonatal circumcision. J Urol 1973; 110: 732-3.

51. Trier WC, Drach GW. Concealed penis. Another complication of circumcision. Am J Dis Child 1973; 125: 276-7.

52. Alter GJ, Horton CE Jr; Horton CE Jr. Buried penis as a contraindication for circumcision. J Am Coll Surg 1994; 178: 487-90.

53. Horton CE, Vorstman B, Teasley D, Winslow B. Hidden penis release: adjunctive suprapubic lipectomy. Ann Plast Surg 1987; 19: 131-4.

54. Donahoe PK, Keating MA. Preputial unfurling to correct the buried penis. J Pediatr Surg 1986; 21: 1055-7.

55. Stewart DH. The toad in the hole circumcision -- a surgical bugbear. Boston Med Surg J 1924; 191: 1216-8.

56. Shapiro SR. Surgical treatment of the "buried" penis. Urology 1987; 30: 554-9.

57. Maizels M, Zaontz M, Donovan J, Bushnick PN, Firlit CF. Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder. J Urol 1986; 136: 268-73.

58. Strimling BS. Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics 1996; 97: 906-7.

59. Sherman J, Borer JG, Horowitz M, Glassberg KI. Circumcision: successful glanular reconstruction and survival following amputation. J Urol 1996; 156: 842.

60. Yilmaz AF, Sarikaya S, Yildiz S, Buyukalpelli R. Rare complication of circumcision: penile amputation and reattachment. Eur Urol 1993; 23: 423-4.

61. Gilbert DA, Jordan GH, Devine CJ Jr, Winslow BH, Schlossberg SM. Phallic construction in prepubertal and adolescent boys. J Urol 1993; 149: 1521-6.

62. Menahem S. Complications arising from ritual circumcision: pathogenesis and possible prevention. Isr J Med Sci 1981; 17: 45-8.

63. Levitt SB, Smith RB, Ship AG. Iatrogenic microphallus secondary to circumcision. Urology 1976; 8: 472-4.

64. Audry G, Buis J, Vazquez MP, Gruner M. Amputation of penis after circumcision--penoplasty using expandable prosthesis. Eur J Pediatr Surg 1994; 4: 44-5.

65. Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989; 142: 799-801.

66. Azmy A, Boddy SA, Ransley PG. Successful reconstruction following circumcision with diathermy. Br J Urol 1985; 57: 587-8.

67. Hanash KA. Plastic reconstruction of partially amputated penis at circumcision. Urology 1981; 18: 291-3.

68. Izzidien AY. Successful replantation of a traumatically amputated penis in a neonate. J Pediatr Surg 1981; 16: 202-3.

69. Money J. Ablatio penis: normal male infant sex-reassigned as a girl. Arch Sex Behav 1975; 4: 65-71.

70. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA. Newborn penile glans amputation during circumcision and successful reattachment. J Urol 1995; 153: 778-9.

71. Brimhall JB. Amputation of the penis following a unique method of preventing hemorrhage after circumcision. St Paul Med J 1902; 4: 490.

72. Neulander E, Walfisch S. Kaneti J. Amputation of distal penile glans during neonatal ritual circumcision -- a rare complication. Br J Urol 1996; 77: 924-5.

73. Hanukoglu A, Danielli L, Katzir Z, Gorenstein A, Fried D. Serious complications of routine ritual circumcision in a neonate: hydro ureteronephrosis, amputation of glans penis, and hyponatraemia. Eur J Pediatr 1995; 154: 314-5.

74. Lerner BL. Amputation of the penis as a complication of circumcision. Med Rec Ann 1952; 46: 229-31.

75. Cetinkaya M, Saglam HS, Beyribey S. Two serious complications of circumcision. Case report. Scand J Urol Nephrol 1993; 27: 121-2.

76. Orozco-Sanchez J, Neri-Vela R. Denudacion total del pene por circuncision. Descripcion de una tecnica de plastia del pene para su correccion. [Total denudation of the penis in circumcision. Description of a plastic technique for repair of the penis] Bol Med Hosp Infant Mex 1991; 48: 565-9.

77. Sotolongo JR Jr; Hoffman S, Gribetz ME. Penile denudation injuries after circumcision. J Urol 1985; 133: 102-3.

78. Smey P. Re: Penile denudation injuries after circumcision. J Urol 1985; 134: 1220.

79. Wilson CL, Wilson MC. Plastic repair of the denuded penis. South Med J 1959; 52: 288-90.

80. Van Duyn J, Warr WS. Excessive penile skin loss from circumcision. J Med Assoc Georgia 1962; 51: 394-6.

81. Brown JB. Restoration of the entire skin of the penis. Surg Gynecol Obstetr 1937; 65: 362-5.

82. Brown JB, Fryer MP. Surgical reconstruction of the penis. GP 1958; 17: 104-7.

83. Ezell WW, Smith EI, McCarthy RP, Thompson IM, Habib HN. Mechanical traumatic injury to the genitalia in children. J Urol 1969; 102: 788-92.

84. Horwitz J, Schussheim A, Scalettar HE. Letter: Abdominal distension following ritual circumcision. Pediatrics 1976; 57: 579.

85. Auerbach MR, Scanlon JW Recurrence of pneumothorax as a possible complication of elective circumcision. Am J Obstet Gynecol 1978; 132: 583.

86. Owen ER, Kitson JL. Plastibell circumcision. Br J Clin Pract 1990; 44: 661.

87. Datta NS, Zinner NR. Complication from Plastibell circumcision ring. Urology 1977; 9: 57-8.

88. Johnsonbaugh RE. Complication of a circumcision performed with a plastic disposable circumision device: long-term follow-up. Am J Dis Child. 979; 133: 438.

89. Malo T, Bonforte RJ. Hazards of plastic bell circumcisions. Obstet Gynecol 1969; 33: 869.

90. Jonas G. Retention of a plastibell circumcision ring: report of a case. Obstetr Gynecol 1984; 24: 835.

91. Rubenstein MM, Bason WM. Complication of circumcision done with a plastic bell clamp. Am J Dis Child. 1968; 116: 381-2.

92. Lackey JT, Mannion RA, Kerr JE. Subglanular urethral fistula from infant circumcision. J Indiana State Med Assoc 1969; 62: 1305-6.

93. Lackey JT, Mannion RA, Kerr JE. Urethral fistula following circumcision. JAMA 1968; 206: 2318.

94. Limaye RD, Hancock RA. Penile urethral fistula as a complication of circumcision. J Pediatr 1968; 72: 105-6.

95. Benchekroun A, Lakrissa A, Tazi A, Hafa D, Ouazzani N. Fistules urethrales après circoncision: à propos de 15 cas. [Urethral fistulas after circumcision: apropos of 15 cases] Maroc Med 1981; 3: 715-8.

96. Lau JT, Ong GB. Subglandular urethral fistula following circumcision: repair by the advancement method. J Urol 1981; 126: 702-3.

97. Shiraki IW. Congenital megalourethra with urethrocutaneous fistula following circumcision: a case report. J Urol 1973; 109: 723-6.

98. Tennenbaum SY, Palmer LS. Congenital urethrocutaneous fistulas. Urology 1994; 43: 98-99.

99. Colodny AH. Congenital urethrocutaneous fistulas. Urology. 1994; 44: 149-50.

100. Johnson S. Persistent urethral fistula following circumcision: report of a case. US Naval Med Bull 1949; 49: 120-2.

101. MacKenzie AR. Meatal ulceration following neonatal circumcision. Obstet Gynecol 1966; 28: 221-3.

102. Meyer HF. Meatal ulcer in the circumcised infant. Med Times 1971; 99: 77-8.

103. Warwick D.J., Dickson W.A.: Keloid of the penis after circumcision. Postgrad. Med. J., 69 (809): 236-7, 1993.

104. Eldin US. Post-circumcision keloid - a case report. Annals of Burns and Fire Disasters 1998;XII(3):174.

105. Köksal T., Kadioglu A., Tefekli A. Keloid as a complication after circumcision. Br J Urol 2000, 85 (6), 1-2.

106. Jee LD, Millar AJ. Ruptured bladder following circumcision using the Plastibell device. Br J Urol 1990; 65: 216-7.

107. Connelly KP, Shropshire LC, Salzberg A. Gastric rupture associated with prolonged crying in a newborn undergoing circumcision. Clin Pediatr Phila 1992; 31: 560-1.

108. Mor A, Eshel G, Aladjem M, Mundel G. Tachycardia and heart failure after ritual circumcision. Arch Dis Child 1987; 62: 80-1.

109. Ruff ML, Clarke TA, Harris JP, Bartels EK, Rosenzweig M. Myocardial injury following immediate postnatal circumcision. Am J Obstet Gynecol 1982; 144: 850-1.

110. Pearlman CK. Caution advised on electrocautery circumcisions. Urology 1982; 19: 453.

111. Pearlman CK. Reconstruction following iatrogenic burn of the penis. J Pediatr Surg 1976; 11: 121-2.

112. Curtis JE. Circumcision complicated by pulmonary embolism. Nurs Mirror Midwives J 1971; 132: 28-30.

113. Redman JF, Scriber LJ, Bissada NK. Postcircumcision phimosis and its management. Clin Pediatr Phila 1975; 14: 407-9.

114. Kaweblum YA, Press S, Kogan L, Levine M, Kaweblum M. Circumcision using the Mogen clamp. Clin Pediatr Phila 1984; 23: 679-82.

115. Patel H. The problem of routine circumcision. Can Med Assoc J 1966; 95: 576.

116. Arnon R, Zecharia A, Mimouni M, Merlob P. Unilateral leg cyanosis: an unusual complication of circumcision. Eur J Pediatr 1992; 151: 716.

117. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949; 2: 1433-7.

118. Sauer LW. Fatal staphylococcus bronchopneumonia following ritual circumcision. Am J Obstetr Gynecol 1943; 46: 583.

119. Willson. Cesarean section for threatened eclampsia and death of the child following circumcision. Am J Obstetr 1913; 68: 351-5.

120. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976; 58: 824-7.

121. O'Brien TR, Calle EE, Poole WK. Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med J 1995; 88: 411-5.

122. Cleary TG, Kohl S. Overwhelming infection with group B beta-hemolytic Streptococcus associated with circumcision. Pediatrics 1979; 64: 301-3.

123. Moreno CA, Realini JP. Infant circumcision in an outpatient setting. Tex Med 1989; 85: 37-40.

124. Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in the pathogenesis. Am J Dis Child 1967; 113: 524-33.

125. Tse S, Barrington K, Byrne P. Methemoglobinemia associated with prilocaine use in neonatal circumcision. Am J Perinatology 1995; 12: 331-2.

126. Mandel S. Methemoglobinemia following neonatal circumcision. JAMA 1989; 261: 702.

127. Ozbek N, Sarikayalar F. Toxic methaemoglobinaemia after circumcision. Eur J Pediatr 1993; 152: 80.

128. Gazarian M, Taddio A, Klein J, Kent G, Koren G. Penile absorption of EMLA cream in piglets: implications for use of EMLA in neonatal circumcision. Biol Neonate 1995; 68: 334-41.

129. Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994; 93: 641-6.

130. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988; 81: 537-41.

131. Enzenauer RW, Dotson CR, Leonard T Jr, Brown J III, Pettett PG, Holton ME. Increased incidence of neonatal staphylococcal pyoderma in males. Mil Med 1984; 149: 408-10.

132. Enzenauer RW, Dotson CR, Leonard T, Reuben L, Bass JW, Brown J III. Male predominance in persistent staphylococcal colonization and infection of the newborn. Hawaii Med J 1985; 44: 389-90, 392, 394-6.

133. Viville C, Weltzer J. Les retrecissements iatrogenes de l'urethre (R.I.U.) masculin. A propos de 50. observations. J Urol Paris 1981; 87: 413-8.

134. Berry CD Jr, Cross RR Jr. Urethral meatal caliber in circumcised and uncircumcised males. Am J Dis Child 1956; 92: 621.

135. Steg A, Allouch G. Stenose du meat et circoncision. [Meatal stenosis and circumcision] J Urol Nephrol Paris 1979; 85: 727-9.

136. Frank JD, Pocock RD, Stower MJ. Urethral strictures in childhood. Br J Urol 1988; 62: 590-2.

137. Graves J. Pinpoint meatus: iatrogenic? Pediatrics 1968; 41: 1013.

138. Meyer HF. Meatal ulcer in the circumcised infant. Med Times 1971; 99: 77-8.

139. Griffiths DM, Atwell JD, Freeman NV. A prospective survey of the indications and morbidity of circumcision in children. Eur Urol 1985; 11: 184-7.

140. Daley MC. Circumcision. JAMA 1970; 214: 2195.

141. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949; 2: 1433-7.

142. Patel H. The problem of routine circumcision. Can Med Assoc J 1966; 95: 576.

143. Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow-up study. Scand J Urol Nephrol 1986; 20: 89-92.

144. Stenram A, Malmfors G, Okmian L. Circumcision for phimosis--indications and results. Acta Paediatr Scand 1986; 75: 321-3.

145. Persad R, Sharma S, McTavish J, Imber C, Mouriquand PD. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Br J Urol 1995; 75: 91-3.

146. Thompson AR. Stricture of the external urinary meatus. Lancet 1935; 1: 1373-7.

147. Brennemann J. The ulcerated meatus in the circumcised child. Am J Dis Child 1921; 21: 38-47.

148. Freud P. The ulcerated urethral meatus in male children. J Pediatr 1947; 31: 131-42.

149. Mastin WM. Infantile circumcision a cause of contraction of the external urethral meatus. Ann Anatomy Surg 1881; 4: 123-8.

150. Metcalf TJ, Osborn LM, Mariani EM. Circumcision: a study of current practices. Clin Pediatr 1983; 22: 575-9.

151. Gracely-Kilgore KA. Penile adhesion: the hidden complication of circumcision. Nurse Pract 1984; 9: 22-4.

152. Marks MB. Preputial adhesions in the circumcised penis. Arch Pediatr 1939; 56: 458-9.

153. Attalla MF, Taweela MN. Pathogenesis of post-circumcision adhesions. Pediatr Surg Int 1994; 9: 103-5.

154. Klauber GT, Boyle J. Preputial skin-bridging. Complication of circumcision. Urology 1974; 3: 722-3.

155. Ritchey ML, Bloom DA. Re: Skin bridge--a complication of paediatric circumcision. Br J Urol 1991; 68: 331.

156. Sathaye UV, Goswami AK, Sharma SK. Skin bridge--a complication of paediatric circumcision. Br J Urol 1990; 66:14.
 

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