title: Circumcision: successful glanular reconstruction and survival following traumatic amputation.
abstract: OBJECTIVE
  Circumcision remains the most common operation performed on male individuals in the United States. Unfortunately various complications may occur during circumcision ranging from trivial to tragic. We report 7 cases of traumatic amputation of the glans penis and/or urethra during circumcision. In addition, errors in circumcision technique as probable mechanisms of injury, principles of repair and limits of tissue viability are discussed.
  
  
  METHODS
  The medical records of 7 patients who underwent traumatic circumcision amputation of the glans penis and/or urethra were reviewed. Glanular amputation occurred in 6, 8-day-old neonates during ritual circumcision and in 1, 5-month-old infant circumcised by a physician.
  
  
  RESULTS
  Excised glanular tissue remained viable up to 8 hours after injury. Followup ranged from 8.5 to 108 months. All patients had an acceptable cosmetic result. No long-term complications developed in the 8-day-old group but a distal urethral fistula formed in the 5-month-old patient.
  
  
  CONCLUSIONS
  Careful selection of technique and device as well as strict attention to detail at circumcision should eliminate most injuries. On the basis of our results we recommend reanastomosis of the glans and/or urethra following distal amputation even when there is a delay in surgical repair of up to 8 hours.
authors.affiliation: Department of Urology, State University of New York Health Science Center, Brooklyn, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sherman
authors.forename: J G
authors.initials: JG
authors.lastname: Borer
authors.forename: M
authors.initials: M
authors.lastname: Horowitz
authors.forename: K I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000673:Amputation, Traumatic / Q000601:surgery*; D002944:Circumcision, Male / Q000295:instrumentation; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D010413:Penis / Q000293:injuries*