This case involves a botched circumcision of a newborn male patient. The physician used a Plastibell Circumcision Device and it appears that the Plastibell ring used was the wrong size, which in turn caused this adverse outcome. The glans of the penis have a large indentation half way through, which will be a permanent lifelong deformity.

Plastibell circumcision is a simple technique for neonatal circumcision. However, the complications of this technique can sometimes be life-threatening and one should take great care in choosing the correct ring size. The reported complications of Plastibell circumcisions range from minor ones to more serious ones. Complications of concern that have been reported in the literature include proximal migration of the bell onto the distal penile shaft causing circumferential compression; denution of penile skin or persistent disfigurement of the glans penis. The commonest Plastibell ring size used was 1.3 cm with sizes ranging from 1.1 to 1.7 cm. The foreskin is freed off the entire glans and completely retracted to expose the whole glans, then the correct size Plastibell is selected by testing it directly on the glans. The foreskin is pulled over the Plastibell which is stabilized by a hemostat clamping the skin to the handle of the Plastibell. The foreskin is excised just past the outermost edge of the Plastibell taking care not to damage the glans. Final checking for bleeding, metal opening and correct position of the tie is performed at the end of the procedure and any damage should be noticed right away.

1. What steps should be taken to ensure the correct ring size of the device is chosen?

Location: Florida M.D., University of South Florida Residency, Obstetrics and Gynecology at University Hospital Fellowship, Gynecologic Oncology at Hospital of the University of Pennsylvania Board Certification: Obstetrics and Gynecology and Gynecology Oncology Active Medical License: FL, PA, NY Fellow, American College of Obstetrics and Gynecology and American Cancer Society Member, American Society of Clinical Oncology Former P******** a* a w******* c***** c*** c***** i* F****** Former A******** D******* D******* o* G********** O******* Former A******** P******** D********* o* O********* a** G********* a* a t** m****** c****** Current C******* A******** P******** a* a F****** m****** c****** Current P******** a* a c***** c***** i* F****** Published 15 peer-reviewed articles

This expert has been a practicing physician for over 20 years and has an expertise in caring for patients with ectopic pregnancy. He is familiar with review of radiology reports for ultrasound examinations for intrauterine or ectopic pregnancies. He has been a medical expert consultant since 2000.

Botched Circumcision of a Newborn Male Patient Results in Permanent Lifelong Deformity

This case involves a child who was circumcised shortly after birth. The surgeon chose to use a Mogen clamp and, according to the medical record, the procedure was conducted without incident. Two years later, the mother of the child noticed something irregular with the infant’s penis and took him for an evaluation. It was determined that the child sustained significant damage to the glans during the circumcision procedure that went unnoticed due to visual obstruction from scar tissue. The child was required to undergo reconstructive surgery and, during the procedure, the surgeon confirmed that part of the child’s glans had been cut during the original procedure.

The Mogen clamp was invented by Rabbi Harry Bronstein in 1954. It consists of two flat blades that open about three mm. Advantages of the Mogen clamp include ease of use and the absence of a foreign body. Disadvantages of the device include a higher risk of glans injury. Because the Mogen clamp hides the glans, the risk of cutting off part of the glans is increased. The entire glans or significant portions of the glans have been amputated accidentally in at least three reported cases.

1. What is the Mogen clamp and are there any advantages or disadvantages in using this device?

Pediatric Urologist Severs Glans of Penis During Circumcision

This case involves a newborn male infant who was the result of a healthy pregnancy and an uncomplicated vaginal delivery. The patient was born full-term and weighed 8 pounds 2 ounces. Physical examination and testing in the neonatal period did not reveal any health problems. At six weeks-old the patient was brought to a pediatrician’s office for to undergo an elective circumcision for religious reasons. The surgery was conducted using a plastibell device. The treating pediatrician forcefully removed the ring during the procedure causing trauma to the penis. This resulted in an extreme bending of the penile shaft, a highly pigmented scar and significant loss of tissue at the glans and shaft at the tip of the penis. The patient required additional surgery, including a degloving procedure to attempt to correct the damage now suffers significant loss of tissue and long-term loss of function as a result of the initial surgery.

This case is very similar to a case that I gave expert witness testimony on in the past. That case also involved a circumcision accident. I evaluated the child every six months for about three years and submitted a report of estimates of psychiatric care to the plaintiff's attorney. In that case, there was still a chance for normal appearance of the penis and function and the child was mostly suffering from medical post-traumatic stress disorder (PTSD) due to repeated corrective surgeries and examinations. It was a difficult estimation to make as the final outcome of the injury was not known at that time. As for social damage and distress in this case, it could be very profound. This type of injury would be comparable to a young female having her face severely disfigured. In my experience, many young men would prefer severe injuries to other part of their bodies, even amputations over loss of penile function. This may have a significant impact on his self-esteem, his sense of masculinity and his future relationships. This child may also suffer medical PTSD should he requires further corrective procedures in the future.

Can you discuss from a psychiatric perspective, the amount of projected social damage and distress this individual is expected to sustain due to a lack of a normal appearing and normal functioning penis?

Location: New Mexico B.S., Massachusetts Institute of Technology M.D., Louisiana State University Residency, General Psychiatry, University of New Mexico Fellowship, Child and Adolescent Psychiatry, University of New Mexico Board Certified, American Board of Psychiatry and Neurology Board Certified, Subspecialty in Child and Adolescent Psychiatry Current A******** P******** C**** a** A********* D******* D********* o* P********* m**** m****** u********* Current C**** P*********** m**** m****** u********* Current D******* o* C**** P********** C*********** S******* m**** m****** u*********

This double board certified expert has been practicing for more than a decade. Fellowship trained in Child and Adolescent Psychiatry, this expert is currently an Associate Professor in the Child and Adolescent Division of a major medical university. He also serves as a Child Psychiatrist as well as the Director of Child Psychiatric Consultation Services at the same institution. This expert has experience with a very similar case and is highly qualified to assess the amount of projected social damage and distress that the plaintiff may face.

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Botched Circumcision of a Newborn Male Patient Results in Permanent Lifelong Deformity

Pediatric Urologist Severs Glans of Penis During Circumcision

Child suffers extreme damage to penis during circumcision

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