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{{Construction Site}}'''Ischemia of the glans penis''' is a not-so-rare [[iatrogenic]] [[complication ]] of [[circumcision]].<refname="pepe2015">{{REFjournal
|trans-title=
|language=
Add category; Wikify.
|last=Pepe
|first=Pietro
|init=P
|author-link=
|last2=Pietropaolo
|first2=Francesco
|init2=F
|author2-link=
|last3=Candiano
|first3=Guiseppe
|init3=G
|author3-link=
|last4=Pennisi
|first4=Michele
|init4=M
|author4-link=
|etal=no
|title=Ischemia of the glans penis following circumcision: case report and revision of the literature
|journal=Arch Ital Urol Androl
|location=
|accessdate=2022-02-20
}}</ref>
==Disruption of blood circulation==
Male [[circumcision]] frequently includes excision of the [[frenulum]], which carries the frenular artery.<ref>{{REFjournal
|last=Shenoy
|first=
|init=SP
|author-link=
|last2=Marla
|first2=
|init2=PK
|author2-link=
|last3=Sharma
|first3=
|init3=P
|author3-link=
|etal=yes
|title=Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique
|journal=J Clin Diagn Res
|location=
|date=2015-12
|volume=9
|issue=12
|article=
|page=
|pages=PC01-PC03
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717729/
|archived=
|quote=
|pubmedID=26816940
|pubmedCID=4717729
|DOI=10.7860/JCDR/2015/14972.6860
|accessdate=2022-02-20
}}</ref> The frenular artery supplies arterial blood to the [[glans penis]], so the excision of the [[frenulum]] reduces the supply of arterial blood to the glans penis.
[[Circumcision]] also disrupts the return flow of blood to the heart. Veins in the [[prepuce]] provide "at least part of the drainage of the [[glans]] surface."<ref name="mcgrath2001">{{REFbook
|last=McGrath
|first=Ken
|init=K
|author-link=Ken McGrath
|year=2001
|title=The Frenular Delta: A New Preputial Stucture
|url=http://www.cirp.org/library/anatomy/mcgrath1/
|work=Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem
|editors=Denniston GC, Hodges FM, Milos MF
|edition=
|volume=
|chapter=
|pages=
|location=New York
|publisher=Kluwer/Plenum
|ISBN=
|quote=
|accessdate=2022-02-20
|note=
}}</ref> Moreover, the dorsal veins from the [[acroposthion]] are severed and excised by [[circumcision]]. This frequently results in post-circumcision [[lymphoedema]] due to the reduction in blood circulation. Ferhatoglu et al. (2019) reported edema in 108 of 198 patients or 54.5 percent, indicating substantial impairment of circulation.<ref>{{REFjournal
|last=Ferhatoglu
|first=
|init=MF
|author-link=
|last2=Kartal
|first2=
|init2=A
|author2-link=
|last3=Gurkan
|first3=
|init3=A
|author3-link=
|etal=no
|title=Evaluation of Male Circumcision: Retrospective Analysis of One Hundred and Ninety-eight Patients
|journal=Cureus
|location=
|date=2019-04-27
|volume=11
|issue=4
|article=
|page=e4555
|pages=
|url=https://www.cureus.com/articles/19380-evaluation-of-male-circumcision-retrospective-analysis-of-one-hundred-and-ninety-eight-patients
|archived=
|quote=
|pubmedID=31275779
|pubmedCID=6592839
|DOI=10.7759/cureus.4555
|accessdate=2022-02-20
}}</ref>
==Case reports==
Tzeng et al. (2004) reported the case of a 33-year-old man who experienceed ischemia of the [[glans penis]] within 24 hours after an [[adult circumcision]]. He was treated with intravenous pentoxifyllin and hyperbaric oxygenation.<ref name="tzeng2004">{{REFjournal
|last=Tzeng
|first=Yuan-Sheng
|init=YS
|author-link=
|last2=Tang
|first2=Shou-Hung
|init2=SH
|author2-link=
|last3=Meng
|first3=En
|init3=E
|author3-link=
|etal=yes
|title=Ischemic glans penis after circumcision
|journal=Asian J Androl
|location=
|date=2004-06
|volume=6
|issue=2
|article=
|pages=161-3
|url=http://www.asiaandro.com/archive/1008-682X/6/161.htm
|archived=
|quote=
|pubmedID=15154092
|pubmedCID=
|DOI=
|accessdate=2022-02-20
}}</ref>
Aslan et al. (2005) reported the case of an eleven-year-old boy who experienced ischemia of the [[glans penis]] within 24 hours of a [[circumcision]]. The boy was successfully treated with pentoxifylline injection for 5 days.<ref name="aslan2005">{{REFjournal
|last=Aslan
|first=Adnan
|init=A
|author-link=
|last2=Karagüzel
|first2=
|init2=G
|author2-link=
|last3=Melikoglu
|first3=
|init3=M
|author3-link=
|etal=no
|title=Severe ischemia of the glans penis following circumcision: a successful treatment via pentoxifylline
|journal=Int J Urol
|location=
|date=2005-07
|volume=12
|issue=7
|article=
|page=
|pages=705-07
|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1442-2042.2005.01129.x
|archived=
|quote=We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.
|pubmedID=16045570
|pubmedCID=
|DOI=10.1111/j.1442-2042.2005.01129.x
|accessdate=2022-02-20
}}</ref>
Devarakonda & Aghavendra (2010) reported a case of ischemia of the [[glans penis]].<ref name="devarakonda2010">{{REFjournal
|last=Devarakonda
|first=
|init=K
|author-link=
|last2=Aghavendra
|first2=
|init2=TR
|author2-link=
|etal=no
|title=A case of ischemia of the glans penis
|journal= Paediatr Anaesth
|location=
|date=2010-06
|volume=20
|issue=6
|article=
|page=
|pages=582-6
|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2010.03312.x
|archived=
|quote=
|pubmedID=20609127
|pubmedCID=
|DOI=10.1111/j.1460-9592.2010.03312.x
|accessdate=2022-02-20
}}</ref>
Karaguzel et al. (2013) reported a case of ischemia of the [[glans penis]] after [[circumcision]] in a four-year-old boy. The boy was successfully treated with pentoxifylline.<ref>{{REFjournal
|last=Karaguzel
|first=
|init=E
|author-link=
|last2=Tok
|first2=
|init2=DS
|author2-link=
|last3=Kazaz
|first3=
|init3=IO
|author3-link=
|etal=yes
|title=Postcircumcisional ischemia of the glans penis treated with pentoxifylline
|journal=Case Rep Urol
|location=
|date=2013-02-04
|volume=
|issue=
|article=
|page=278523
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575659/
|archived=
|quote=
|pubmedID=23431492
|pubmedCID=3575659
|DOI=10.1155/2013/278523
|accessdate=2022-02-20
}}</ref>
Pepe et al. (2015) reported the case of a young man who had ischemia of the [[glans]] five days after [[circumcision]]. He was treated with hyperbaric therapy.<ref name="pepe2015"/>
Cárdenas Elías et al. (2016) reported a case of ischemia of the [[glans penis]] in a ten-year-old patient with symptoms appearing two hours after circumcision. The boy was treated with pentoxifylline (PTX) that is maintained for 6 days, topical testosterone and a caudal blocking (for 48 hours).<ref>{{REFjournal
|last=Cárdenas Elías
|first=
|init=MÁ
|author-link=
|last2=Rueda
|first2=
|init2=FV
|author2-link=
|last3=Crespo
|first3=
|init3=VJ
|author3-link=
|etal=yes
|title=Isquemia postcircuncisión: una complicación inesperada. Revisión de la literatura
|trans-title=An unexpected complication: glans ischemia after circumcision. Review of the literature
|language=Spanish
|journal=Cir Pediatr
|location=
|date=2016-07
|volume=29
|issue=3
|article=
|page=
|pages=127-30
|url=https://pubmed.ncbi.nlm.nih.gov/28393509/
|archived=
|quote=
|pubmedID=28393509
|pubmedCID=
|DOI=
|accessdate=2022-02-20
}}</ref>
Migliorini et al. (2018) reported a case of ischemia of the [[glans penis]] after [[circumcision]] in a 24-year-old male. The patient was successfully treated with hyperbaric oxygen therapy in combination with pentoxifylline.<ref>{{REFjournal
|last=Migliorini
|first=Fillipo
|init=F
|author-link=
|last2=Bianconi
|first2=Francesco
|init2=F
|author2-link=
|last3=Bizzotto
|first3=Leonardo
|init3=L
|author3-link=
|etal=yes
|title=Acute Ischemia of the Glans Penis after Circumcision Treated with Hyperbaric Therapy and Pentoxifylline: Case Report and Revision of the Literature
|journal=Urol Int
|location=
|date=2018-02-13
|volume=100
|issue=3
|article=
|page=
|pages=361-3
|url=https://www.karger.com/Article/Abstract/444399
|archived=
|quote=
|pubmedID=26871688
|pubmedCID=
|DOI=10.1159/000444399
|accessdate=2022-02-20
}}</ref>
Polak et al. (2021) present two cases of ischemia of the [[glans penis]] after medically-unnecessary, non-therapeutic [[circumcision]] in which hyperbaric oxygen was used as salvage therapy to save the penises of the newborn boys.<ref name="polak2021">{{REFjournal
|last=Polak
|first=Nir
|init=N
|author-link=
|last2=Fisheley
|first2=Gregory
|init2=G
|author2-link=
|last3=Lang
|first3=Erez
|init3=E
|author3-link=
|etal=yes
|title=Hyperbaric Oxygen as Salvage Therapy for Neonates Suffering From Critical Ischemia of the Glans Penis After Circumcision
|journal=Urology
|location=
|date=2021-03
|volume=149
|issue=
|article=
|page=
|pages=e48-e51
|url=https://www.goldjournal.net/article/S0090-4295(20)31134-1/fulltext
|archived=
|quote=
|pubmedID=32956687
|pubmedCID=
|DOI=10.1016/j.urology.2020.09.006
|accessdate=2022-02-20
}}</ref>
==Conclusion==
The medical literature has a number of reports of successful treatment of ischemia of the [[glans penis]]. But what of the cases in which treatment was not timely instituted and the case progressed to [[necrosis]] and gangrene of the [[glans penis]]?
Ischemia of the glans penis after [[circumcision]] is not an act of God. It is an [[iatrogenic]] occurrence that happens when medical personnel intentionally sever blood vessels in the [[penis]] and reduce the blood circulation into and through the [[glans penis]].
A surgical operation which severs blood vessels and impedes circulation cannot be viewed as other than harmful. The first rule of medical ethics is ''premum non nocere''. First do no harm. The typical infant [[circumcision]] is a non-therapeutic amputation that harms without providing a benefit such as prevention or treatment of disease.
Tasci et al. (2020) report that the Turkish Institution of Forensic Medicine has undertaken the consideration of 24 cases of necrosis of the penis after circumcision with regard to malpractice.<ref name="tasci2020">{{REFjournal
|last=Tasci
|first=
|init=AI
|author-link=
|last2=Danacioglu
|first2=
|init2=YO
|author2-link=
|last3=Arikan
|first3=
|init3=Y
|author3-link=
|etal=yes
|title=Management of post-circumcision necrosis of the penis: the medicolegal aspect
|journal=Pediatr Surg Int
|location=
|date=2020-02-22
|volume=36
|issue=4
|article=
|pages=523-8
|url=
|archived=
|quote=
|pubmedID=32088740
|pubmedCID=
|DOI=10.1007/s00383-020-04630-2
|accessdate=2022-02-20
}}</ref> Medical doctors should be aware than such cases may be viewed by a future court as malpractice.
The public is reminded that the usual infant [[circumcision]] does not treat or cure disease, because disease is not present. It is classified as without medical indication, non-therapeutic, and medically-unnecessary, but puts the patient at risk.
{{REF}}
[[Category:Circumcision complication]]
[[Category:Circumcision risk]]
[[Category:Circumcision term]]