Outcomes in men undergoing complex circumcision: An aid to consent and litigation

Abstract

Introduction & Objectives: Circumcision is a common procedure and in complex pathology can be difficult even in expert hands. Litigation for unexpected or poor outcomes is also not uncommon. There is limited data on clinical outcomes in complex circumcision. Here we report initial data from a tertiary referral centre, to highlight complications which may help in consenting of patients. Materials & Methods: A retrospective cohort review of men undergoing a circumcision between 2015 and 2020 was performed. Review of operation notes, pre- & postoperative clinical notes and histology were utilized to record relevant parameters. We included men undergoing complex circumcision which included Redo-circumcision, circumcision for glans adherence (>50%), circumcision with the addition of: wide local excision glans lesion, excision of primary cancer of foreskin, urethral meatal dilatation. Those undergoing circumcision in the setting of a Glansectomy were excluded. Results: Records identified 197 cases of circumcision. Mean age 63.1 yrs, (21 – 92yrs). Of 97 complex circumcisions 24 were performed for pre-operative diagnosis of severe phimosis, 48 for suspected cancer, 13 for lichen sclerosis, 3 were redo circumcisions for residual penile cancer, 7 for PeIN and 2 for severe condylomata. 39 were confirmed cancer cases of which 19 were T1a and 17 T1b. 3 cases revealed T2. Grading of the malignant cases was 7 of grade 1, 15 of grade 2 and 17 grade 3. Complications occurred in 7%: 2 (2%) infections requiring antibiotics, 1 (1%) change in sensation and 1 (1%) patient unhappy with cosmesis. 3 (3%) patients complained of skin tightness. Bleeding, return to theatre within 30 days, erectile dysfunction, wound breakdown and glans dryness occurred at a rate of 0%. Circumcision alongside a further procedure in the same sitting was performed in 29 of the cases including 11 biopsies and 17 wide local excisions of lesions on the glans and 1 urethral dilatation. Positive margins reported in 3 cases they did not experience any post-operative complications. Conclusions: Complex Circumcision can be a difficult procedure. Our data show that when performed at a tertiary centre complications are lower than expected and cosmetic complaints are minimal. When complete this data will be beneficial in consenting and litigation