Published 2022-04-28
Budi Suwarno Ogi Bahaurini Gumilar Achmad Romy Syahrial Rozidi Rahmat Sayyid Zharfan


Objective: In this report, we describe the case of urethral injuries after circumcision. Case(s) Presentation: A 5-year-old male came to the urology clinic complaining of urine seeping through the gauze-covered wound. The patient had undergone circumcision. Before the procedure, the patient could generally urinate through the external urethral orifice. His parent realized that the urine was flowing out through the circumcision scar instead of the external orifice. Even though the wound was open and wet, he felt painless when urinating. After cleaning the wound, it appeared that there was a sizeable chromic catgut thread knotted on the right corpus cavernosum. The pendular urethra was cut widely; therefore, the urine came out of this spot. A six French Foley catheter was inserted over the external urethral orifice, the cut urethra towards the bladder. The injured urethra was expected to be attached to simplify the next six-month operation by inserting this urinary catheter. Discussion: Urethral injury post circumcision is rarely reported, but this complication is dangerous due to its morbidity and long-term impact. The paradigm shift from two-stage repair to one-stage repair has developed. Mathieu’s modified technique and the Snodgrass technique are recommended. Conclusion: Urethral injury during circumcision can be devastating. The repair technique for urethral trauma depends on the involvement and condition of the surrounding soft tissue, also the size of the tissue damage.



circumcision, complications, fistula, pediatric, urethral injury


Simpson E, Carstensen J, Murphy P. Neonatal Circumcision: New Recommendations & Implications for Practice. Mo Med. 2014; 111(3): 222–30.

Raisin G, Kocherov S, Jaber J, Shenfeld O, Hardak B, Chertin B. Glans injury during ritual circumcision. J Pediatr Urol. 2020; 16(4): 471.e1-471.e5.

Sidani M, Au JK, Elizondo RA, Iii TGS, Roth DR. Animal bite of genitalia in a child : A rare case of anterior urethral injury. Pediatr Urol Case Reports. 2016; 3(4): 128–33.

Salle JLP, Jesus LE, Lorenzo AJ, Romao RLP, Figueroa VH, Bagli DJ, et al. Glans amputation during routine neonatal circumcision : Mechanism of injury and strategy for prevention. J Pediatr Urol. 2013; 9: 763–8.

Frisch M, Simonsen J. Cultural background , non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease : Two nationwide register-based cohort studies in Denmark 1977 - 2013. Surgeon. 2018; 16(2): 107–18.

Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates , infants and children: a systematic review. BMC Urol. 2010; 10(2).

Atıcı A, Çelikkaya ME, Akçora B. A rare complication following circumcision , severe urethral fistula located on the distal penile shaft and the coronal margin: A case report. Ped Urol Case Rep. 2018; 5(1): 1–4.

Sancaktutar AA, Pembegül N, Bozkurt Y, Kolcu B, Tepeler A. Multiple Circumferential Urethrocutaneous Fistulae as a Rare Complication of Circumcision and Review of Literature. Urology. 2011; 77(3): 728–9.

Osifo OD, Odion-obomhense H, Osagie TO. Repair-oriented categorization of circumcision urethral injury in Benin city , Nigeria. J Pediatr Urol. 2013; 9(2): 206–11.

Manentsa M, Mukudu H, Koloane N, Ringane A, Matta E, Martinson NA, et al. Complications of high volume circumcision: Glans amputation in adolescents; A case report. BMC Urol. 2019; 19(1): 1–4.

Ugino RT da S, Pasqual S, Farias AK, Dias AIB dos S, Stratigis JD, Falcão BP, et al. Management of traumatic urethral injuries in children using different techniques: A case series and review of literature. Int J Surg Case Rep. 2017; 40: 85–9.

Ikuerowo SO, Bioku MJ, Omisanjo OA, Esho JO. Urethrocutaneous fistula complicating circumcision in children. Niger J Clin Pract. 2014; 17(2): 145–8.

Agrawal A, Parelkar S, Shah H, Sanghvi B, Joshi M, Mishra P. Multiple circumferential urethrocutaneous fistulae : A rare complication of circumcision. J Pediatr Urol. 2009; 5(3): 240–2.

Faydaci G, Uǧur K, Osman C, Şermin Ş, Bilal E. Amputation of glans penis: A rare circumcision complication and successful management with primary anastomosis and hyperbaric oxygen therapy. Korean J Urol. 2011; 52(2): 147–9.

Krill AJ, Palmer LS, Palmer JS. Complications of Circumcision. Sci World J. 2011; 11: 2458–68.

Çetinkaya M, Saǧlam HS, Beyribey S. Two serious complications of circumcision: Case report. Scand J Urol Nephrol. 1993; 27(1): 121–2.

Khaireddine B, Adnen H, Khaled BM, Adel S. Surgical reimplantation of penile glans amputation in children during circumcision. Urol Ann. 2014; 6(1): 85–7.

Soltani S, Mottaghi M, Jafarpisheh A, Tavakkoli M. Penile Glans Amputation following Circumcision: A Case Report of a Rare Complication. Case Rep Urol. 2020: 1–3.

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Department of Urology, Faculty of Medicine/Airlangga University