references

[beru]

Hi,
I am looking for journal article references for two things:
1. incidence of meatal stenosis (in general public and/or in circumcised boys)
2. rates on the use of anesthesia in newborn circumcision.

For the second, I haven't seen a reference since the early 90s. I am thinking it must have changed a lot since then because of the AAP's recommendation.

I am preparing to give some information to a pregnant friend and she is a scientist by profession. She will not be impressed with anecdotal info or DOC or NOCIRC stuff. She will respect the medical association stuff and peer-reviewed research...Hopefully, she'll be open to plain old logic also which is all she should really need to be convinced.

Thanks

[tutucrazy]

Originally Posted by beru

Hi,
I am looking for journal article references for two things:
1. incidence of meatal stenosis (in general public and/or in circumcised boys)
2. rates on the use of anesthesia in newborn circumcision.

For the second, I haven't seen a reference since the early 90s. I am thinking it must have changed a lot since then because of the AAP's recommendation.

I am preparing to give some information to a pregnant friend and she is a scientist by profession. She will not be impressed with anecdotal info or DOC or NOCIRC stuff. She will respect the medical association stuff and peer-reviewed research...Hopefully, she'll be open to plain old logic also which is all she should really need to be convinced.

Thanks

The incidence of meatal stenosis is 8 in 100 circumcised boys. This condition is virtually unseen in intact boys. circumstitions.com has this info but i will have to look for it b/c it has been a while since I was researching this. I have a policy statement by the Royal Australasian College of Physicians. This document is very clinical and perfect for medical professionals. She will probably respond to that better. PM me your email address and I can send it. It is in PDF format.

As for pain relief. This is where you will have a hard time finding actual %s THis is b/c doctors don't have a set requirement. Most doctors just try to do it quick and don't use a penile block. Then some doctors might give it but not wait the full 10 minutes for it to take effect. There is a ton of variation with circ b/c doctors have essentially no guidelines set forth to protect boys from pain. The percentage of boys who actually get an EFFECTIVE penile block is around 5% for all of North America. This statistic is from around 2002, but I am not sure much has changed. If you watch the film Cut and some other films where doctors discuss doing circumcisions you will see many doctors say that they don't bother with the nerve block injection and rather just try to operate as quickly as possible.

[Pumpkinheadmommy]

Here is a good one on meatal stenosis:
http://emedicine.medscape.com/article/1016016-overview

[SeekingJoy]

Not the OP, but thank you for that link! I just sent it on to a friend who plans to circ her son "to prevent infection to his future partners" and "research" her DH did. Crazy logic there, but I hope I can offer more info on the subject.

[Quirky]

Personally I don't focus so much on the pain relief aspect, because it IS possible to get the best pain relief possible if you insist on it. So the fact that OTHER babies get circed without pain relief doesn't necessarily mean that HER baby will, KWIM?

What about focusing on the scientific papers on the functions of the foreskin? After all, as brutal as it is, the pain of the circ itself will go away, but the foreskin is gone forever, no getting it all back even with restoration.

She probably assumes, as do many Americans (and esp. American doctors), that the "side effects" of circumcision are pain, bleeding, infection, etc. but no one ever discusses what is lost to circumcision. It's benefits of circ on the one side and complications of circ on the other with no discussion of the 100% risk of the loss of the feelings and functions of the foreskin.

Here are some good papers, peer-reviewed and published in the British Journal of Urology:

http://www.cirp.org/library/anatomy/cold-taylor/

http://www.cirp.org/library/anatomy/taylor/

http://www.cirp.org/library/anatomy/sorrells_2007/

[glongley]

Re: rates of anesthesia use: More docs are being taught the use of anesthesia nowadays, but it is still not used by all. It is also acknowledged that even when it is used that while it may reduce the level of pain, it has not been shown to completely eliminate the pain. Also, there are ethical issues to be considered - namely, use of anesthesia does not make an unethical procedure ethical.

Here are a few references:

From 2004 AAP COnference, reporting very low rates of use at major hospital in large mid-western city.
http://www.medscape.com/viewarticle/491035

Yawman D, Howard CR, Auinger P, Garfunkel LC, Allan M, Weitzman M. Pain relief for neonatal circumcision: a follow-up of residency training practices. Ambul Pediatr 2006;6 (4):210-214. http://www.medicalnewstoday.com/articles/54127.php
Higher rates of training, but not used as consistently. Probably far lower rates of use in those not in academic settings, or who were trained in earlier years.

Taeusch HW et al. Pain during Mogen or Plastibell circumcision. J Perinatology 2002;22(3):214-8.
http://www.nature.com/jp/journal/v22...f/7210653a.pdf
Even when DPNB used, "we judged that 60% of the infants had pain or discomfort associated with the procedure that was excessive."

Brady-Fryer B et al. Pain Relief for neonatal circumcision. Cochrane Database of Systematic Reviews 2004, Issue 3. http://www.cochrane.org/reviews/en/ab004217.html
Conclusions [my paraphrase]: DPNB and EMLA do not eliminate circumcision pain, but they're better than nothing.

Key articles on neonatal pain, and its long-term effects:
Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-1329. http://www.cirp.org/library/pain/anand/

Anand KJS, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biology of the Neonate. Feb 2000;77(2):69-82. http://www.cirp.org/library/pain/anand4/

An article on ethical problems with the studies of pain relief for neonatal circumcision:
J Law Med Ethics. 2008 Winter;36(4):803-23, 611.
Neonatal pain relief and the Helsinki Declaration.
Van Howe RS, Svoboda JS.

ABSTRACT: The Helsinki Declaration is the universally accepted standard for ethical behavior in research involving human subjects. The Declaration calls for research studies to compare new therapies to the best current therapies. Despite this standard, multiple studies of pain relief interventions in newborns have recruited placebo controls instead of active controls using the best current therapy. These studies are evaluated using the standards required by the Helsinki Declaration, and the reasons for the ethical shortcomings of these studies are explored.

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Gillian