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Neonatal Circumcision

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1. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (Full Version)

Introduction Circumcision is the oldest planned operative procedure in the history of the human civilization, but there continues to be a lack of consensus and strong opposing views on whether universal neonatal circumcision should be adopted as a public health measure. The recent American Academy of Pediatrics (AAP) guideline on male circumcision (MC) reversed its prior stand, stating that the “health benefits of newborn male circumcision outweigh the risks,” and justify access to the procedure (...) Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (Full Version) CUAJ • February 2018 • Volume 12, Issue 2 © 2018 Canadian Urological Association E76 CUA GUideline Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) Cite as: Can Urol Assoc J 2017;12(2):E76-99. http://dx.doi.org/10.5489/cuaj.5033 Published online December 1, 2017

2018 Canadian Urological Association

2. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (Abridged Version)

in the history of human civilization, but there continues to be a lack of consensus and strong opposing views on whether universal neonatal circumcision should be adopted as a pub- lic health measure. The American Academy of Pediatrics 2012 guideline on male circumcision (MC), reversed its prior stand, stating that the “health benefits of newborn male circumcision outweigh the risks” and justify access to the procedure if the parents so choose. 1 The following set of guidelines will investigate and pro- vide (...) Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (Abridged Version) CUAJ • February 2018 • Volume 12, Issue 2 © 2018 Canadian Urological Association CUA gUideline 18 Cite as: Can Urol Assoc J 2018;12(2):18-28. http://dx.doi.org/10.5489/cuaj.5034 Published online December 1, 2017 See related commentary on page 29 For full version, visit cuaj.ca Introduction Circumcision is the oldest planned operative procedure

2018 Canadian Urological Association

3. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial Full Text available with Trip Pro

Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set (...) in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time.Neonatal Infant Pain Scale scores were significantly lower in the intervention groups

2018 EvidenceUpdates

4. Newborn male circumcision

Newborn male circumcision The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections (...) , including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male. Key Words: Circumcision; HIV; HPV; HSV; Infant; STI; UTI

2015 Canadian Paediatric Society

5. Newborn Male Circumcision for the Prevention of Sexually Transmitted Infections, Urinary Tract Infections, and Cancer

Newborn Male Circumcision for the Prevention of Sexually Transmitted Infections, Urinary Tract Infections, and Cancer Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within (...) Circumcision for the Prevention of Sexually Transmitted Infections, Urinary Tract Infections, and Cancer: Clinical Effectiveness and Guidelines DATE: 6 February 2015 RESEARCH QUESTIONS 1. What is the clinical effectiveness of newborn male circumcision for the prevention of sexually transmitted infections (STIs), urinary tract infections (UTIs), and cancer? 2. What are the evidence-based guidelines regarding the medical indications for newborn male circumcisions? KEY FINDINGS Seven systematic reviews and 16

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

6. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Full Text available with Trip Pro

Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Neonatal circumcision is a fairly common surgical procedure that may be carried out for medical reasons, one of them being prevention of urinary tract infections (UTI) in male infants. Circumcision could help in reducing the incidence of UTI by reducing periurethral bacterial colonization, which is accepted as a potential risk factor in UTI. Evidence is needed to inform the benefits or harm for the routine (...) use of this intervention.To assess the effectiveness and safety of routine neonatal circumcision for the prevention of UTIs in infancy.We searched the Cochrane Neonatal Review Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We completed this search 30 June 2011.Randomised controlled trials and quasi-randomised controlled trials.Two review authors had planned

2012 Cochrane

7. Costs and effectiveness of neonatal male circumcision Full Text available with Trip Pro

Costs and effectiveness of neonatal male circumcision Costs and effectiveness of neonatal male circumcision Costs and effectiveness of neonatal male circumcision Kacker S, Frick KD, Gaydos CA, Tobian AA Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions (...) drawn. CRD summary This study examined the clinical and economic impact of a reduced rate of newborn male circumcision, in the USA. The authors concluded that reducing the rate of male circumcision increased the infection prevalence and medical costs, for both men and women. Limited details of the data sources were given, but extensive sensitivity analyses were carried out, which showed that the authors’ conclusions were robust. Type of economic evaluation Cost-effectiveness analysis Study objective

2012 NHS Economic Evaluation Database.

8. Evaluating Clinical Outcomes of an Advanced Practice Provider Led Newborn Circumcision Clinic. (Abstract)

Evaluating Clinical Outcomes of an Advanced Practice Provider Led Newborn Circumcision Clinic. To determine the safety and efficacy of Advanced Practice Provider (APP) performed NBCs, we reviewed outcomes of NBCs performed by pediatric urologists and APPs. We hypothesize comparable clinical outcomes between the groups.All urology performed NBCs during a 5 year period were reviewed, including time surrounding implementation of the APP led clinic. Return to Emergency Department (ED) rates, return (...) and weight, with urologists performing NBCs on older and heavier patients. There was no difference in clinical outcomes between children over and under 10 pounds (4.5kg). There was a significant difference in the need for revision circumcision when comparing children older versus younger than 30 days (1.9% vs 0%, p = 0.034).An APP led NBC clinic is both safe and feasible. The widely used age and weight cutoffs for NBC need to be further evaluated, as there was no significant difference in clinical

2019 Urology

9. Sharara-Chami et al. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial. Full Text available with Trip Pro

Sharara-Chami et al. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial. 29712767 2019 02 25 1098-4275 141 5 2018 05 Pediatrics Pediatrics Sharara-Chami et al. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial. Pediatrics. 2017;140(6):e20171935. e20180500 10.1542/peds.2018-0500 eng Journal Article Published Erratum 2018 04 30 United States Pediatrics 0376422 0031-4005 Pediatrics. 2017 Dec;140(6): 29150457 2018 5 2 6 0 2018 5 2 6 1 2018 5

2018 Pediatrics Controlled trial quality: predicted high

10. UROFLOWMETRY BEFORE AND AFTER MEATOTOMY IN BOYS WITH SYMPTOMATIC MEATAL STENOSIS FOLLOWING NEONATAL CIRCUMCISION - A LONG-TERM PROSPECTIVE STUDY. (Abstract)

UROFLOWMETRY BEFORE AND AFTER MEATOTOMY IN BOYS WITH SYMPTOMATIC MEATAL STENOSIS FOLLOWING NEONATAL CIRCUMCISION - A LONG-TERM PROSPECTIVE STUDY. To assess uroflowmetry in the long-term follow-up of symptomatic meatal stenosis patients prior to and following meatotomy. Severity of symptoms and treatment success has been defined by patient history, physical examination, and witnessed voiding. Uroflowmetry might add objective parameters for the assessment, however long-term data are lacking.A

2018 Urology

11. Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques Full Text available with Trip Pro

Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques It was intended to compare meatal stenosis (MS) as a late complication of neonatal circumcision by using two different methods of Plastibell Device circumcision.A total of 2,307 healthy term newborns (6-36 hours) who were born between 2007 and 2009 in Niknafs Medical Center of Rafsanjan, Iran, were simply randomized into two groups in a controlled, nonblinded clinical trial (...) A was 8.5% (94) and in group B was 13.7% (165), which was statistically significant (P<0.001). At 16 months after circumcision, in the frenulum intact group, MS was 13.8% (152) and in the cautery group, it was 18.9% (228), which was compatible with significant difference (P=0.001).Our experience with large group of cases revealed that neonatal circumcision by using Plastibell Device with intact frenulum technique decreases the rate of delayed MS.

2018 Research and reports in urology Controlled trial quality: uncertain

12. The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health Full Text available with Trip Pro

The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current (...) statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.Copyright © 2018 Korean Society for Sexual Medicine and Andrology.

2018 The world journal of men's health

13. Physicians' and nurses' thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study. Full Text available with Trip Pro

Physicians' and nurses' thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study. Neonatal male circumcision (NMC) is an alternative approach to adult male circumcision for HIV prevention. Recent studies found that NMC was rarely performed in Thailand and that most Thai health professionals did not recognize that NMC could reduce the risk of HIV infection and would not want NMC services in their hospitals. This study explored the thoughts and concerns

2018 BMC health services research

14. Neonatal Circumcision and Urinary Tract Infections in Infants With Hydronephrosis. Full Text available with Trip Pro

Neonatal Circumcision and Urinary Tract Infections in Infants With Hydronephrosis. Boys with urinary tract abnormalities may derive a greater benefit from newborn circumcision for prevention of urinary tract infection (UTI) than the general population. However, the effect of newborn circumcision on UTI is not well characterized across the etiological spectrum of hydronephrosis. We hypothesized that boys with an early diagnosis of hydronephrosis who undergo newborn circumcision will have reduced (...) rates of UTI.The MarketScan data set, an employer-based claims database, was used to identify boys with hydronephrosis or hydronephrosis-related diagnoses within the first 30 days of life. The primary outcome was the rate of UTIs within the first year of life, comparing circumcised boys with uncircumcised boys and adjusting for region, insurance type, year of birth, and infant comorbidity.A total of 5561 boys met inclusion criteria, including 2386 (42.9%) undergoing newborn circumcision and 3175

2018 Pediatrics

15. Penile reconstruction in a newborn following complicated circumcision: A case report Full Text available with Trip Pro

Penile reconstruction in a newborn following complicated circumcision: A case report Grade V post-circumcision penile injury is known as "total phallic loss". It is usually seen with the use of mono-polar electro-cautery for circumcision resulting in penile necrosis. We report on a newborn treated by release of the subcutaneous corporal remnant and explain why this option should be considered of choice in cautery-related Grade V injuries.A 25-day old Saudi Arabian newborn with Grade V penile (...) injuries include sex-reassignment, phallic reconstruction using flaps, and release of the subcutaneous corporal remnant. We demonstrate that the latter option should be considered of choice in cautery-related Grade V injuries because there is usually preservation of the most proximal part of the corpora of the shaft which becomes retracted under the skin. Hence, the released remnant is of adequate length.Post-circumcision Grade V penile injuries of the newborn are best reconstructed with release

2018 International journal of surgery case reports

16. A Newborn with Simmering Bleeding after Circumcision Full Text available with Trip Pro

A Newborn with Simmering Bleeding after Circumcision We present a case of a healthy male neonate born at term, circumcised on Day 1 of life. Facing ongoing bleeding at the incision site, the baby was transferred to a level III neonatal intensive care unit for further investigation and management. His family history was unremarkable for bleeding disorders. On arrival, the baby was hemodynamically stable with abnormal coagulation values. Further investigations revealed a diagnosis compatible (...) with severe hemophilia A. He deteriorated on Day 2, developing acute severe anemia which required two red blood cell transfusions. This rare but potentially fatal event reminds clinicians to remain extremely vigilant with minor surgical procedures such as circumcision even in the absence of family history.

2018 Cureus

17. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version) Full Text available with Trip Pro

Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version) 29381455 2018 11 13 1911-6470 12 2 2018 Feb Canadian Urological Association journal = Journal de l'Association des urologues du Canada Can Urol Assoc J Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). 18-28 10.5489/cuaj.5034 Dave Sumit S Department of Surgery

2017 Canadian Urological Association Journal

18. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) Full Text available with Trip Pro

Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) 29381458 2018 11 13 1911-6470 12 2 2018 Feb Canadian Urological Association journal = Journal de l'Association des urologues du Canada Can Urol Assoc J Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). E76-E99 10.5489/cuaj.5033 Dave Sumit S Department of Surgery (Urology

2017 Canadian Urological Association Journal

19. Neonatal Circumcision

Avoid excessive manipulation of the penile frenulum (volar band at base of glans) Leave foreskin clamp (e.g. Gomco Clamp) on for 5 minutes during Circumcision Apply copious vaseline to and leave applied to cut foreskin edge for 24 hours VII. Resources Stanford Newborn Nursery Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Neonatal Circumcision." Click on the image (or right click) to open the source website in a new browser (...) Neonatal Circumcision Neonatal Circumcision Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Neonatal Circumcision Neonatal

2018 FP Notebook

20. Defining the Pathways of Parental Decision-Making and Satisfaction Levels About Newborn Circumcision in a Setting Where Traditional Male-Circumcision is Prevalent - an Online Survey Study. (Abstract)

Defining the Pathways of Parental Decision-Making and Satisfaction Levels About Newborn Circumcision in a Setting Where Traditional Male-Circumcision is Prevalent - an Online Survey Study. To investigate the decision-making attitudes, course of informed consent, and satisfaction levels of parents who opted for newborn circumcision (NC) in a societal setting where the timing of circumcision is generally determined by tradition.Online questionnaire was sent to 1235 parents of boys who had NC.The (...) response rate was 50.4%. The final decision of newborn circumcision depended on the mother in 51.47%. Nearly 75% of circumcisions were performed before hospital discharge. The most common (70.65%) reported reason for parents' choice was medical/hygienic. When evaluating their decision, 93.05% refused any feelings of regret and 96.26% stated they would decide the same if they had another son. The source of information on newborn circumcision was mostly physicians (39.27%), followed by friends and family

2016 Urology

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