American Academy of Pediatrics Section on Urology
View all recommendations from this societyReleased January 4, 2022
Do not perform newborn clamp circumcision in boys with anatomic penile anomalies including hypospadias, chordee, penile torsion, or penoscrotal webbing without first consulting with a urologist.
In 2012, the American Academy of Pediatrics Task Force on Circumcision listed hypospadias, congenital chordee, and deficient shaft skin (penoscrotal fusion/webbing or buried penis) as contraindications to newborn circumcision. For patients with hypospadias, preservation of the prepuce is important for use in future reconstruction. Additionally, abnormal urethral anatomy may predispose to urethral injury during clamp circumcision. As such, best practice dictates consulting a urologist to help assess these anatomic penile anomalies prior to initiation of circumcision.
Newborns with a circumferentially normal foreskin may undergo completion of clamp circumcision without concern for concealed hypospadias. In this situation, if a hypospadias is present, it is usually on the glans of the penis, and clamp circumcision should not increase the risk for future complications if hypospadias repair is needed.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The AAP Section on Urology (AAP SOU) Executive committee worked together to develop five items in the practice of Pediatric Urology of tests or procedures that should not be done routinely. Approximately 11 members of this committee participated in the process. They submitted items from their practices and experiences of tests or procedures they found were commonly over-utilized. The committee then agreed on a final list of 5 based on incidence and importance of the condition. Educational committee fellows then reviewed the appropriate guidelines and literature to provide references and support for each item. The AAP SOU Education committee reviewed the 5 listed items and provided further feedback then approved the list, descriptions, and references. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics 2012;130(3) e756-e786; DOI: 10.1542/peds.2012-1990
Lerman, S. E. & Liao, J. C. Neonatal circumcision. Pediatr Clin North Am 48, 1539-1557, doi:10.1016/s0031-3955(05)70390-4 (2001).
Snodgrass, W. T. & Khavari, R. Prior circumcision does not complicate repair of hypospadias with an intact prepuce. J Urol 176, 296-298, doi:10.1016/S0022-5347(06)00564-7 (2006).
Chalmers, D., Wiedel, C. A., Siparsky, G. L., Campbell, J. B. & Wilcox, D. T. Discovery of hypospadias during newborn circumcision should not preclude completion of the procedure. J Pediatr 164, 1171-1174.e1171, doi:10.1016/j.jpeds.2014.01.013 (2014).
Zamilpa, I., Patel, A., Booth, J., Canon, S. To Finish the Cut or Not: Should Neonatal Circumcisions Be Completed or Aborted in Patients with Unrecognized Glandular Hypospadias? Clin Pediatrics. 2017 Feb;56(2):157-161. Doi: 10.1177/0009922816648287
