Pediatric urologist comments on neonatal complications

 

By Dr. M. David Gibbons

Neonatal circumcision is totally unnecessary, and there is no current role for preventative or prophylactic neonatal circumcision.

Unfortunately, 70-80% of neonatal circumcisions are performed by obstetricians, who can neither manage their complications (2-5% incidence) nor obtain proper informed consent (defined as outlining risks and benefits of a procedure, as well as alternatives-including nothing) for neonatal circumcision. Currently, the American College of OB-GYN (ACOG) have no paramenters [sic] for training (learning and performing neonatal circumcision, managing complications) of residents, who then go out and continue this practice.

In my practice, as a pediatric urologist, I manage the complications of neonatal circumcision. For example, in a two year period, I was referred >275 newborns and toddlers with complications of neonatal circumcision. None of these were ‘revisions’ because of appearance, which I do not do. 45% required corrective surgery (minor as well as major, especially for amputative injury), whereupon some could be treated locally without surgery.

Complications of this unnecessary procedure are often not reported, but of 300 pediatric urologists in this country who have practices similar to mine…well, one can do the math, to understand the scope of this problem…let alone, to understand the adverse cost-benefit aspect of complications (>$750,000) in this unfortunate group of infants and young children.

Fortunately, neonatal circumcision is on the decline as parents become educated…but the complications still continue.

Until the time that the USA falls in step with the rest of the planet who does not submit newborns to neonatal circumcision, ACOG should assure that the training of obstetricians to perform this procedure is adequate, particularly in avoiding and managing complications of a procedure that is unnecessary, and that obstetricians learn to obtain proper informed consent from parents who have no idea of the problems that can ensue.

M. David Gibbons, MD, has practiced pediatric urology in the Washington, DC, area for 20 years. Working primarily in Northern Virginia and in DC, Dr. Gibbons has been recognized five times by Washingtonian magazine in its annual “Top Doctors” issue. Dr. Gibbons received his medical degree from the Medical College of Virginia, and his subspecialty interests include evaluation of the fetus with urological abnormalities, intersex abnormalities, and complex genital reconstruction