TITLE:
Penile and Scrotal Complications of Male Circumcision: A Narrative Review with Insights from Three Salvaged Complications from Traditional Circumcisions in Our Setting
AUTHORS:
Frank Obeng, Aishah Fadila Adamu, Karen Michelle Anyebanying Whittal, Ali Mamudu Ayamba
KEYWORDS:
Circumcision, Traditional Circumcision, Penile Complications, Scrotal Injuries, Scar Outcomes, Pediatric Urology, Reconstructive Surgery
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.1,
December
31,
2025
ABSTRACT: Background: Circumcision is one of the most common surgical procedures globally, yet complications remain prevalent in traditional practice where untrained practitioners often operate under unsafe conditions. This remains a preventable cause of penile-scrotal morbidity in children. This review uses three index cases to illustrate the wound-healing and scarring consequences of traditional circumcision in Ghana, while contextualizing them within the broader literature. Methods: Three pediatric cases from South-Eastern Ghana were reviewed: a 4‑month-old male with penoscrotal denudation, and two boys aged two and four years with post-circumcision phimosis, meatal stenosis, and buried penis. A narrative review of 120 screened records with 24 included relevant articles was conducted (PubMed, Scopus, Cochrane, Google Scholar) to synthesize evidence on circumcision complications, reconstructive strategies, and scar-related outcomes. We then illustrated key injury patterns with the three paediatric cases managed in the study area. Results: Case 1 (penoscrotal denudation) was reconstructed with dartos-fasciocutaneous flaps; complete epithelial coverage by postoperative day 7. Case 2 (post-circumcision phimosis + meatal stenosis, buried penis) underwent release + meatotomy/meatoplasty; meatal calibre improved from 2 French to 8 French at 2 weeks. Case 3 (phimosis + meatal stenosis) had release + meatotomy/meatoplasty; peak urinary stream increased from “pin-hole” to a continuous stream with post-void residual 0 mL at 2 weeks. Across the literature, common complications included infection, haemorrhage, penile skin loss, urethral fistula, phimosis, and meatal stenosis; timely salvage using local flaps and meatotomy/meatoplasty yielded favourable outcomes. Conclusions: Training and oversight for traditional circumcisers, aseptic technique, and early referral reduce morbidity. Reconstruction using dartos-fasciocutaneous flaps and meatotomy/meatoplasty are effective salvage options in resource-limited settings.