Notat om omskæring af drenge - Sundhedsstyrelsen

FROM THE AMERICAN ACADEMY OF PEDIATRICS(slit-like) space between them anda mechanism that draws the bladestogether and locks them in place. Theslit is limited to 3 mm to allow theforeskin, but not the glans, to crossthe opening. The preputial adhesionsare gently taken down by a probe andthe glans pushed downward, therebyprotecting it from the blades. Theprepuce distal to the glans is drawninto the slit between the blades andpositioned. The blades are locked together,crushing the skin and creatinghemostasis. The skin is excised fromabove the clamp. The clamp is removedand the skin pushed proximallyinto proper position.There were no specific studies ofcomplications of the Mogen becausecomplications are rare; thus, one canonly rely on available case reports ofamputation. 201,202,222–228ComparisonA study with fair evidence evaluatedthe use of the Gomco versus thePlastibell device in 350 newborninfants. 229 The incidence of infectionwas higher with the Gomco clamp(2%) versus a lower complication rate(1.3%) with the Plastibell device.Adhesions were also more commonwith the Gomco clamp, at a rate of20% vs 6.6% for the Plastibell device.Stratification of RisksBased on the data reviewed, it isdifficult, if not impossible, to adequatelyassess the total impact ofcomplications, because the data arescant and inconsistent regarding theseverity of complications. For example,studies that report bleeding asa complication do not uniformly reporthow frequently the bleeding wascontrolled with local measures versusrequiring a transfusion or surgicalintervention. Similarly, infectionis rarely further divided into localtissue infection versus bacteremia orsepsis. Financial costs of care, emotionaltolls, or the need for futurecorrective surgery (with the attendantanesthetic risks, family stress,and expense) are unknown.Some reports have attempted tocompare potential benefits of circumcisionwith reported complicationrates. One study with good evidenceattempted to estimate complicationrates compared with benefits frommale circumcision. Based on an estimatethat 100 circumcisions mustbe performed to prevent 1 UTI, and909 circumcisions must be performedto prevent 1 case of penile cancer,the study yields an estimate of 1complication for every 5 UTIs preventedand 2 complications for every1caseofpenilecancerprevented. 121Assuming an overall minor adverseevent rate for newborn circumcisionof 0.2%, and a severe adverse eventrate of 0.005%, another study withfair evidence estimated that over322 000 newborn male circumcisionsare required to prevent 1 case of penilecancer per year. 122 Similar modelingfor HIV, herpes, and HPV in theUnited States is not available.A recently published CDC study foundthat male circumcision before theage of sexual debut was cost-effectivefor the prevention of HIV. 60 The studydid not take into account the positivebenefits of newborn circumcision forother conditions such as costs ofcaring for UTIs. 106,107,110,112,230–233 Italso did not include recent evidencethat circumcision (either as an infantor later in life) is associated withreduced risk for other STIs, penileand cervical cancers, phimosis, andpenile dermatoses. 36,88,234,235 Theauthors did not include adverseeffects that make newborn circumcisionless cost-effective, such asbleeding, infection, and revision. Consideringall these factors, however,the authors concluded that malecircumcision was a cost-effectivestrategy for HIV prevention in theUnited States. 60Workforce Development and MaleCircumcision Task Force Recommendations:8 Physicians counseling familiesabout elective male circumcisionshould assist parents byexplaining, in a nonbiasedmanner, the potential benefitsand risks, and by ensuring thatthey understand the electivenature of the procedure.8 Parents are entitled to factuallycorrect, nonbiased informationabout circumcision that shouldbe provided before conceptionand early in pregnancy,when parents are mostlikely to be weighing the optionof circumcision of a malechild.8 Parents of newborn boysshould be instructed in thecare of the penis at the timeof discharge from the newbornhospital stay, regardless ofwhether the newborn is circumcisedor not.8 Male circumcision should beperformed by trained andcompetent practitioners, byusing sterile techniques andeffective pain management. Analgesiais safe and effectivein reducing the proceduralpain associated with newborncircumcision; thus, adequateanalgesia should be providedwhenever newborn circumcisionis performed.8 Key professional organizations(AAP, AAFP, ACOG, the AmericanSociety of Anesthesiologists,the American College ofNurse Midwives, and othermidlevel clinicians such asPEDIATRICS Volume 130, Number 3, September 2012Downloaded from pediatrics.aappublications.org by guest on June 19, 2013e775