Notat om omskÃƒÂ¦ring af drenge - Sundhedsstyrelsen

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Weiss et al. BMC Urology 2010, 10:2http://www.biomedcentral.com/1471-2490/10/2Page 3 of 13surgical procedure in haeomphiliacs is associated with ahigh risk of post-operative bleeding and is not representativeof general populations.Complications following neonatal or infant circumcisionWe identified 16 prospective studies of complicationsfollowing neonatal and infant circumcision, from 12countries [9-11,21-33] (Table 1). Of these, most usedthe Plastibell [11,22,23,25-28], with others using theGomco clamp [21,24,30,32], freehand circumcision[9,31], or a combination of methods [27,29,33].The median frequency of any adverse event was 1.5%(range 0-16%), and median frequency of any seriousadverse event was 0% (range 0-2%). Nine studies reportedno serious adverse events, but three studies reported that1-2% of boys had a serious complication [10,27,29]. One, aCanadian study of 100 neonates circumcised in 1961/1962using the Gomco clamp or Plastibell reported one severeinfection requiring antibiotics and one severe meatal ulcer[29]. Less severe complications were reported in a further13 boys in this study. The other two studies with seriouscomplications were from Nigeria. In one, among 141 boyscircumcised in 3 hospitals in southeast Nigeria, complicationswere assessed at a 6 week post-operative visit or ifthey presented earlier with any complication [27]. Threeboys (2.1%) had a urethral laceration. The most commoncomplications in this study were minor including bleeding(9%) and meatal stenosis (3.5%). Complications were substantiallymore common when circumcision had been performedfreehand (27% excluding incomplete circumcision)rather than using the Plastibell (8%), and when performedby midwives (19%) rather than doctors (7%). Moreover,among the doctors, the reported frequency of complicationsat the public (University Teaching) hospital was1.6%, compared to 20% at private hospitals where the levelof training and supervision is lower. A much higher frequency(90%) was seen at the mission hospital, which actsas a referral centre for complicated circumcisions. Threecircumcisions had been performed by a traditional birthattendant, and all three had resultant complications (onebleeding, one incomplete circumcision, and one urethralfistula). The other study was among 322 infants attendinga welfare clinic in Ibadan [10], in which there were 2 casesof amputation of the glans penis and one buried (trapped)penis. Overall in this study, complications were reportedin 9.3% of boys, with a further 11% having excess residualforeskin. The most common complication was excessiveloss of foreskin (n = 16; 5%). Unusually, no cases of bleeding,wound infection, or haematoma were reported in thisstudy. The method used was not reported for the majorityof infants, and complications were most frequent whenthe procedure was performed by nurses rather than doctorsor traditional circumcisers (data not given).Of the remaining 13 studies, five reported adverseevents in 0.3% or fewer boys [9,22,26,30,32], four inaround 2% [11,21,23,25], and the remaining four studiesreported adverse events in up to 16% of boys[24,28,31,33]. The studies with highest frequency ofcomplications are from Pakistan and the United Kingdom(UK). The study from Pakistan reports on 200infants circumcised under local anaesthesia at a MilitaryHospital using either the freehand or bone-cuttermethod (a forceps-guided method which does not shieldthe glans) [31]. Bleeding (defined as requiring more thanan application of a pressure bandage) was reported in9% of boys, and 7% had a local infection of the skin andmucosa. In the UK study, 1129 infants were circumcisedby nurses using the Plastibell under local anaesthesia[28], and overall 125 (11.1%) of infants required somedegree of follow-up, with complications seen in 5.5%.The most common complication involved the Plastibellring device itself (3.6%), which is left on after the procedureand normally takes 7-10 days to fall off. The problemsincluded delayed separation of the ring,incomplete separation of the ring, or the ring becomingstuck on the penile shaft. In all cases, the ring wasremoved without need of anaesthesia and the authorsreport this removal was quick, simple and atraumatic.Three studies reported substantial variation in complicationfrequencies by age or circumcision method. Forexample, a US study of circumcision by the Gomcoclamp stratified by age at circumcision and found nocomplications in 98 boys circumcised neonatally, butthat 12/32 (30%) of infants aged 3-8.5 months had postoperativebleeding requiring suture repair [24]. These 32boys were circumcised under general anaesthesia and nocomplications from the general anesthesia werereported. In another study, complications were seenmore frequently using the Plastibell (12/381; 3.1%) thanthe sleeve technique (4/205; 1.95% [33]).A further ten studies on neonatal/infant circumcisionwere retrospective hospital-record based studies (Table2). Five of these were from the USA, two from Pakistan,one each from Israel, Oman and Turkey. Reported frequencyof complications were slightly lower than for theprospective studies, with five studies finding very lowfrequencies (≤0.6%) [19,34-37] and four in the range 2-4% [38-41]. The study reporting the highest proportion(4% in neonates, 10% in infants) included late complications(most commonly foreskin adhesions (7.8%)), with3 cases (1.3%) of meatitis and 3 requiring circumcisionrevision (1.3%) [42]. As with prospective studies in neonatesand infants, few serious adverse events werereported (
Weiss et al. BMC Urology 2010, 10:2http://www.biomedcentral.com/1471-2490/10/2Page 4 of 13Table 1 Prospective studies of frequency of complications in studies of neonatal and infant circumcisionAuthor Country No. ofpatientsAl Samarrai[11]Amir d [21]Banieghbal[32]Ben Chaim[9]SaudiArabiaSaudiArabiaSouthAfricaAge Type of provider Method Follow-up period Frequency ofadverseevents a2000 2-3 days Junior staff withsupervision1000 Mean 9daysPlastibell6 weeks plusimmunisationclinic visits1.4% c 0%Surgeon Gomco clamp 1 year 1.6% 0%583 Neonatal Surgeon Gomco clamp 1 month 0.3% 0%Israel 19,478 Mean 8days83% Mohel17% PhysicianFreehand - 0.1% 0.1%Bhat [22] Oman 250 Neonatal Paediatrician Plastibell - 0% 0%(min 1 day)Duncan[23]Jamaica 205 Neonatal Surgeon Plastibell 1 week 1.5% 0%Horowitz[24]USA 130 98 neonatal32 infants(3-8.5months)Manji [25] Tanzania 368 7 days to 9monthsMousavi[33]Pediatric urologist Gomco clamp 3 days Overall: 7.4%Neonatal: 0%Infants: 30%Pediatrician Plastibell - 2.8% e 0%Iran 586
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OMSKÆRINGAF DRENGENotat2013
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Indhold1 Sundhedsstyrelsens sammenf
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1 Sundhedsstyrelsens sammenfatningO
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døgn under indlæggelse på sygehu
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arnet ligger på en pude på et bor
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se områder i Afrika. WHO understre
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3 Omskæring i DanmarkFor en del å
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Hvis en person, der hverken er læg
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4 Omskæring i andre landEfter Sund
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sundhedsmæssige fordele ikke er tu
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6 Bilagsfortegnelse:Bilag 1:Sundhed
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WHITEPAPER- OM RITUEL OMSKÆRELSE A
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OM RITUEL JØDISK OMSKÆRELSE AF DR
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White Paper om religiøs omskærels
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har været oppe med jævne mellemru
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To tredjedel færre infektioner på
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Der er en betydelig risiko for, at
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2.3 Beskrivelse af afrapporteringen
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3.5 Betydningen for den jødiske fa
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Page 45 and 46: Endvidere skal lægen i fornødent
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Page 51 and 52: TECHNICAL REPORTMale Circumcisionab
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Page 55 and 56: FIGURE 2Prevalence of male circumci
Page 57 and 58: TABLE 2 Results from Medline, Cochr
Page 59 and 60: Male Circumcision and Diseases,Morb
Page 61 and 62: een diagnosed with genital herpes a
Page 63 and 64: Results data indicate that the inci
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Page 67 and 68: without general anesthesia in boys
Page 69 and 70: was reported in 2.2% of cases andin
Page 71 and 72: nurse practitioners) should workcol
Page 73 and 74: circumcision practices in theUnited
Page 75 and 76: at: www.cdc.gov/hiv/resources/facts
Page 77 and 78: childhood: a meta-analysis. Pediatr
Page 79 and 80: multicenter survey. Isr Med Assoc J
Page 81 and 82: Male CircumcisionTASK FORCE ON CIRC
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Page 85 and 86: COMMENTARYIn this commentary, a dif
Page 87 and 88: COMMENTARYThe cardinal medical ques
Page 89 and 90: Cultural Bias in the AAP's 2012 Tec
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