title: Unexpected Complications Following Adult Medical Male Circumcision Using the PrePex Device.
abstract: BACKGROUND
  In this study, we describe and depict unexpected sequelae of adult medical male circumcision (MMC) using the PrePex device.
  
  
  METHODS
  The PrePex system is an elastic compression device for adult MMC. The device is well studied, has been pre-qualified by the World Health Organization (WHO), and its use is being scaled-up in African countries targeted by WHO. We conducted a PrePex implementation study in routine service delivery among 427 men in the age range of 18-49 in western Kenya. We captured penile photographs to create a record of adverse events (AEs) and to monitor healing. Several unexpected AEs ensued, including some that have not been reported in other PrePex studies. We describe and depict those unexpected complications and resulting treatments to alert circumcision providers in the relevant areas.
  
  
  RESULTS
  We observed 5 device displacements (1.2%); 3 cases of early sloughing of foreskin tissue (0.7%) among men with long foreskins; 2 cases of a long foreskin obstructing urine flow, as it became dry and necrotic (0.5%); and 2 cases of insufficient foreskin removal caused by invagination for which surgical completion was necessary (0.5%). All of the participants healed completely by day 42 post-circumcision or shortly thereafter.
  
  
  CONCLUSIONS
  The potential for these complications should be incorporated into PrePex training programs. Integration of devices into MMC programs in medically underserved areas requires the availability of prompt surgical intervention for some sequelae, particularly displacement events.
authors.affiliation: Formerly at Nyanza Reproductive Health Society, Kisumu, Kenya.
authors.forename: Elijah
authors.initials: E
authors.lastname: Odoyo-June
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feldblum
authors.forename: Shelly
authors.initials: S
authors.lastname: Fischer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Walter
authors.initials: W
authors.lastname: Obiero
authors.forename: Catherine
authors.initials: C
authors.lastname: Hart
authors.forename: Valentine
authors.initials: V
authors.lastname: Veena
authors.forename: Stephanie
authors.initials: S
authors.lastname: Combes
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology*; D052816:Foreskin / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010865:Pilot Projects; D013997:Time Factors; D016896:Treatment Outcome; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology*; D014945:Wound Healing; D055815:Young Adult