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This information is taken from references: [Wiswell & Geschke, 1989; Wiswell, 1992; Wiswell, 1995; Wiswell, 1997a; Alanis & Lucidi, 2004]. This is treated with pressure or locally-acting agents, but 1 in 4,000 may require a ligature, and 1 in 20,000 may need a blood transfusion because they have a previously unrecognized bleeding disorder.Hemophilia in the family is of course a contra-indication for circumcision.These included 62 local infections, 83 instances of hemorrhage (31 requiring ligatures and 3 requiring transfusion), 25 instances of surgical trauma, 20 urinary tract infections (com,pared with 88 UTIs in the 35,929 boys in this study who had not been circumcised), and 8 cases of bacteremia (compared with 32 in the uncircumcised).

Dr Kunin is acknowledged for the clinical explanations and advice above.

He says that it is important to equate a given complication with what tool is used, but overall complications should approach zero for an experienced operator.

Thus risk was very low even in an old study like this one.

A study in 2005 of 19,478 circumcisions in Israel (on day 8 after birth), and made up of 83% ritual circumcisions and 17% involving a physician, found a complication rate of 0.34% [Ben Chaim et al., 2005]. Dr Kunin says that if a baby is chubby, has an abundant prepubic fat pad or scrotal swellings from hydrocele or hernia it may look like not enough skin has been removed, when in reality the circumcision has been a good one.

Infection: Local infections occur in 1 in 100-1,000 and are easily treated with local antibiotics.

Systemic infections may appear in 1 in 4,000 and require intravenous or intramuscular injection of antibiotics.Thus, in this study, complications were rare, mild and virtually all easily correctable, with little difference in rate between ritual and medical circumcisions.An overall summary of the various complications of circumcision in infancy and the rates of each appears below.It was then calculated that 6 UTIs could be prevented for every circumcision complication, and 1 penile cancer could be prevented for every 2 complications.Of 9,668 neonatal circumcisions performed in Kaiser Permanente Northern California hospitals none resulted in complications [Schoen et al., 2006].Adhesions can develop between the glans penis and the remnant of the foreskin.To avoid this, parents must be instructed to routinely push the skin off the glans.Inclusion cysts can occur, most often with the Mogen procedure, since freeing up the foreskin from the glans is blind and does not include cleaning out smegma, which becomes trapped in the line of the clamp to form a cyst.In Gomco and Plastibell a dorsal slit in the foreskin is made after clamping and at this time all inner connections can be released and smegma removed.Subsequent surgery: Needed for 1 in 1,000 because of skin bridges, or removal of too much or too little foreskin.Repair of injury to penis or glans required for 1 in 15,000.

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