title: Prevalence of preoperative penile abnormalities among voluntary male medical circumcision patients in Swaziland.
abstract: BACKGROUND
  Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughout the country. During many of these circumcisions, genital medical conditions and penile abnormalities are simultaneously discovered and corrected.
  
  
  OBJECTIVE
  The goal of our study was to evaluate the prevalence of penile abnormalities discovered and treated during voluntary male medical circumcisions performed by The Luke Commission (TLC) throughout rural Swaziland.
  
  
  METHODS
  We completed a retrospective analysis of all male patients who underwent voluntary male medical circumcision performed by TLC during a period from June-August, 2014. The penile abnormalities included: phimosis, paraphimosis, epispadias, hypospadias, ulcers, balanitis, torsion, and foreskin adherent to the glans.
  
  
  RESULTS
  Of 929 total circumcisions, 771 (83%) patients had at least one pre-existing penile abnormality identified during their examinations and procedures, totaling 1110 abnormalities. Three specific abnormalities were detected - phimosis, adherent foreskin, and hypospadias. The 6-12 and 13-19 age groups had adequate sample sizes to yield precise estimates of prevalence (age group 6-12: 87% (95% confidence interval [CI]=84-90%; age group 13-19: 79% (95% CI=74-84%).
  
  
  CONCLUSIONS
  The Luke Commission is improving the lives of children and adults with limited access to healthcare through regular preoperative evaluations during male circumcision, and the organization is setting an example for other international healthcare groups.
  
  
  METHODS
  Type of Study: Prognostic Study, Level II.
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: oddo.2@wright.edu.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Oddo
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: Ruedrich.2@wright.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ruedrich
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: zust.2@wright.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Zust
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: marugg.2@wright.edu.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Marugg
authors.affiliation: The Luke Commission, Miracle Campus, Box 41, Sidvokodvo, Swaziland. Electronic address: vanderwal@lukecommission.org.
authors.forename: Echo
authors.initials: E
authors.lastname: VanderWal
authors.affiliation: The Luke Commission, Miracle Campus, Box 41, Sidvokodvo, Swaziland. Electronic address: vanderwal@lukecommission.org.
authors.forename: Harry
authors.initials: H
authors.lastname: VanderWal
authors.affiliation: The Luke Commission, Miracle Campus, Box 41, Sidvokodvo, Swaziland. Electronic address: rebekah.sartori@lukecommission.org.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Sartori
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: ronald.markert@wright.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Markert
authors.affiliation: Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn, Highway, Dayton, OH 45435. Electronic address: mary.mccarthy@wright.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D013541:Eswatini / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology*; D010413:Penis / Q000002:abnormalities* / Q000601:surgery; D057234:Preoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D012424:Rural Population; D035141:Voluntary Programs / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Circumcision; HIV; Penile abnormalities; Swaziland