Page 1360 - TNFlipTest

U42 Urology
Selected Urological Procedures
Toronto Notes 2019
Newborn Male Circumcision
Paediatr Child Health 2015;20(6):311-15
Study: Position Statement by the Canadian Paediatric Society (CPS) reaffirmed Feb 28, 2018 Recommendations: With the exception of some high-risk populations and circumstances where circumcision
is indicated for disease prevention, reduction and/or treatment, the routine circumcision of every newborn male is not recommended.
Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men
Cochrane DB Syst Rev 2009;2:CD003362
Purpose: To evaluate the effectiveness and safety of male circumcision for preventing acquisition of HIV in heterosexual men.
Methods: The analyzed data is from three randomized controlled trials to assess the efficacy of male circumcision for preventing HIV acquisition in men in Africa.
Results: Medical male circumcision reduces the acquisition of HIV by heterosexual men (38-66% over
24 mo).
Circumcision Status and Risk of HIV and Sexually Transmitted Infections among Men who have Sex with Men: A Meta-Analysis
JAMA 2008;300:1674-1684
Purpose: To describe the association between male circumcision and HIV infection and other sexually transmitted infections (STIs) among men who have sex with men (MSM).
Methods: Meta-analysis of 15 studies (n=53,567) Results: The associations between circumcision and HIV-positive and STIs were not statistically significant. Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active anti-retroviral therapy.
Conclusions: There is insufficient evidence to support that male circumcision protects against HIV infection or other STIs.
Circumcision
Definition
• removalofsomeoralloftheforeskinfromthepenis
Epidemiology
• 30%worldwide
• frequencyvarieswithgeography,religiousaffiliation,socioeconomicstatus
Medical Indications
• phimosisandrecurrentparaphimosis
• recurrentUTIs(particularlyininfantsandinassociationwithotherurinaryabnormalities) • balanitisxeroticaobliteransorotherchronicinflammatoryconditions
Contraindications
• unstableorsickinfant
• congenitalgenitalabnormalities(hypospadias)
• familyHxofbleedingdisorderswarrantslaboratoryinvestigationpriortocircumcision
Complications
• bleeding
• infection
• penileentrapment,skinbridges • fistula
• glansinjury
• penilesensationdeficits
Cystoscopy
Objective
• endoscopicinspectionofthelowerurinarytract(urethra,prostate,bladder,andureteralorifices), samples for cytology
• scopescanbeflexibleorrigid
• doneunderlocalanesthesiaonly,formajority
Indications
• grosshematuria
• LUTS(storageorvoiding)
• urethralandbladderneckstrictures
• bladderstones
• bladdertumoursurveillance
• evaluationofuppertractswithretrogradepyelography(uretericstents,catheters)
Complications
• duringprocedure ■ bleeding
■ anesthetic-related
■ perforation(rare)
• post-procedure(short-term)
■ infections (antibiotic prophylaxis recommended)
■ urinary retention
• post-procedure(long-term)
■ stricture