Case Report Highlights Risks of Iatrogenic Hypospadias Following Traditional Circumcision in Young Child

Traditional circumcisions may cause complications such as hemorrhage, infection, amputations of the penis, meatal stenosis, and urethro-cutaneous fistula. In addition to all these complications, iatrogenic hypospadias, as in our case, is a rare condition. In general, complications are mild and preventable, especially in children, but when the procedure is carried out by unskilled providers, in unsterile conditions, or with inadequate equipment and supplies, severe complications are more likely to occur. Several degrees of urethral erosion, including iatrogenic hypospadias, might result from further injury. Particularly in intensive care facilities, the ventral male urethra can undergo this kind of trauma.

The case described involves a 4-year-old child who underwent circumcision at the age of 3 and subsequently experienced significant bleeding. Four months later, his parents took him to the hospital. Upon examination, the glans appeared normal, but there was an opening near the glans at the distal urethra, located at the subcoronal level.

After a thorough pre-operative evaluation, the child was prepared for elective surgery. During the procedure, an incision was made to expose the fistula tract, with marker sutures placed around the edges for guidance. The fistula opening was then repaired using 6/0 PDS (polydioxanone) sutures, and a second layer was created over the repair before closing the skin with 4/0 Vicryl (polyglactin) sutures.