**10. Different opinions & arguments in neonatal circumcision**

It is a custom: The most important, arguments are those of custom and tradition.

It confers beauty: It is difficult to evaluate the consideration of beauty since these are subjective. In cultures where circumcision is norm, young women find the uncircumcised penis radiculously ugly. Young ladies refuse intercourse without wearing an appropriate brooch through his penis.

It promotes health: through the prevention of venereal diseases, cancer of the penis and cervix uteri. Hutchinsons in 1891, the greatest syphilologist suggested that, the presence of the foreskin constitutes a constant source of irritation leading to high risk of syphilis in early life and cancer in the aged. Penile cancer is never seen in a Jew and chancres are rare.

In some countries, insurance excluded infants under the age of 15 years. The reason was that the money used to pay for the possible unnecessary circumcisions would cover much of the cost of emerging neonatal and premature intensive care units. Circumcision is done when the boy is more than one day old and after he has been checked for bleeding tendency (Blandy et al, in 1968).

There are children who are brought in by their parents for circumcision for ethnic or social reasons (Shanon et al., 1979).

On the other hand, the risk cost- effectiveness and medical resources should probably be allocated to health measures of demonstrated value. Laumann et al. in 1997, in The National Health and Social life survey, indicated that there are no significant differences between circumcised and uncircumcised men in contracting sexually transmitted diseases.

Merits and Arguments Related to Circumcision 49

2. The suture line may become infected specially by Staphylococcal infection. (Annunziato

3. Meatal stenosis is probably the most common potentially adverse result of neonatal circumcision. Lacking of the foreskin coverage leads to irritation and inflammation of the meatal tissues by the very alkaline urine formed after meals. This leads to stenosis or meatal adhesions. Formal meatotomy is required when the stream is very fine in

4. Bleeding from an artery or vein. Shulman et al. in 1964, reported that the most common complication in 800 infants undergoing ritual circumcision by Mohels on the 8th day of

5. Removal of excessive skin of the penile shaft along with the prepuce. On healing of the wound, the penis sets buried in the scrotum. This results in a concealed or denuded penis. Repair is complicated by the lack of the available skin to cover the shaft of the

6. If the urethra is grapsed in the circumcision clamp or from stitches placed in the

7. Penile glans amputation during circumcision. Sherman et al. in 1996, reported seven cases of traumatic amputation of the glans penis and/or urethra during circumcision due to errors in the circumcision technique. The excised glandular tissue remains viable up to eight hours after injury. Reanastomosis of the glans and/or urethra following distal amputation even when there is a delay in the surgical repair of up to eight hours

9. Complete avulsion of the skin of the penis and scrotum (Malherbe, 1975). Shulman et al. in 1964, reported that 1:800 would develop complications requiring admission to the hospital, e.g., necrosis of the glans, laceration of the scrotum and removal of the entire

The laser beam cuts as well as controls bleeding from the skin, resulting in a very tidy wound. This technique allows exact proportions of skin and mucous membrane to be removed. Laser circumcision is the technique of choice for children circumcision and can also be applied to adult patients. Clinical comparative studies between the Neodymium:yttriumaluminumgarnet (Nd:YAG) laser and conventional circumcision in boys are very few. Vaos compared the clinical effects of the Nd:YAG laser contact technique with those of a conventional technique on the grounds of certain perioperative parameters, including operative time, length of hospital stay, postoperative complications and morbidity. Seventy-five patients undergoing circumcision were reviewed retrospectively. Operative time, length of hospital stay, and postoperative morbidity were analyzed. The study concluded the Nd:YAG laser contact technique is an effective laser-assisted procedure alternative to the conventional technique in

Similar study using Carbon dioxide laser circumcision found this technique to reduce operative time translating into cost effectiveness. Morbidity rates of laser circumcision

circumcision with virtually no significant postoperative morbidity (Vaos,2004).

compared favorably to those of conventional circumcision (How et al 2003).

urethra, the injury is usually a fistula at the corona (Shulman et al., 1964).

life in Jews is haemorrhage which occurs in ten patients.

8. Gangrene of the penis and scrotum (Du-Toit & Villet in 1979).

and Goldbum in 1978).

calibre (Blandy et al., 1968).

is usually successful.

penile skin.

**14. Laser circumcision** 

penis. (Radhakrishnan & Reges, 1984).

Also, uncircumcised men appear slightly more likely to experience sexual dysfunction especially later in life. Their results support the view that physicians and parents must be informed about potential benefits and risks of circumcision.

Tran and Giacomantanio in 1996, reported that the increased rate of penile cancer among uncircumcised men appears to justify the procedure but that alone is not sufficient justification. The final decision in neonatal circumcision should be made by parents with balanced counsel from the attending physicians. The Infectious Disease Committee of the Canadian of Society in 1996, stated that circumcision of newborns should not be routinely performed.
