PMID- 33579261
OWN - NLM
STAT- MEDLINE
DCOM- 20210722
LR  - 20210722
IS  - 1471-2490 (Electronic)
IS  - 1471-2490 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Feb 12
TI  - Urethrocutaneous fistulas after voluntary medical male circumcision for HIV 
      prevention-15 African Countries, 2015-2019.
PG  - 23
LID - 10.1186/s12894-021-00790-y [doi]
LID - 23
AB  - BACKGROUND: Voluntary medical male circumcision (VMMC) is an HIV prevention 
      strategy recommended to partially protect men from heterosexually acquired HIV. 
      From 2015 to 2019, the President's Emergency Plan for AIDS Relief (PEPFAR) has 
      supported approximately 14.9 million VMMCs in 15 African countries. 
      Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin 
      through which urine can escape, are rare, severe adverse events (AEs) that can 
      occur with VMMC. This analysis describes fistula cases, identifies possible risks 
      and mechanisms of injury, and offers mitigation actions. METHODS: Demographic and 
      clinical program data were reviewed from all reported fistula cases during 2015 
      to 2019, descriptive analyses were performed, and an odds ratio was calculated by 
      patient age group. RESULTS: In total, 41 fistula cases were reported. Median 
      patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients 
      aged < 15 years. Fistulas were more often reported among patients < 15 compared 
      to >/= 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% 
      confidence interval [CI] = 8.6-2060.0)). Median time from VMMC surgery to 
      appearance of fistula was 20 days (interquartile range (IQR) 14-27). CONCLUSIONS: 
      Urethral fistulas were significantly more common in patients under age 15 years. 
      Thinner tissue overlying the urethra in immature genitalia may predispose boys to 
      injury. The delay between procedure and symptom onset of 2-3 weeks indicates 
      partial thickness injury or suture violation of the urethral wall as more likely 
      mechanisms of injury than intra-operative urethral transection. This analysis 
      helped to inform PEPFAR's recent decision to change VMMC eligibility policy in 
      2020, raising the minimum age to 15 years.
FAU - Lucas, Todd
AU  - Lucas T
AUID- ORCID: 0000-0002-8785-1830
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA. tlucas@cdc.gov.
FAU - Hines, Jonas Z
AU  - Hines JZ
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
FAU - Samuelson, Julia
AU  - Samuelson J
AD  - Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, 
      Switzerland.
FAU - Hargreave, Timothy
AU  - Hargreave T
AD  - Department of Surgery, Edinburgh University, Scotland, UK.
FAU - Davis, Stephanie M
AU  - Davis SM
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
FAU - Fellows, Ian
AU  - Fellows I
AD  - Fellows Statistics, Contractor, Centers for Disease Control and Prevention, San 
      Diego, CA, USA.
FAU - Prainito, Amber
AU  - Prainito A
AD  - U.S. Office of the Global HIV/AIDS Coordinator, Washington, DC, USA.
FAU - Watts, D Heather
AU  - Watts DH
AD  - U.S. Office of the Global HIV/AIDS Coordinator, Washington, DC, USA.
FAU - Kiggundu, Valerian
AU  - Kiggundu V
AD  - Office of HIV/AIDS, U.S. Agency for International Development, Washington, DC, 
      USA.
FAU - Thomas, Anne G
AU  - Thomas AG
AD  - Department of Defense, Defense Health Agency, San Diego, CA, USA.
FAU - Ntsuape, Onkemetse Conrad
AU  - Ntsuape OC
AD  - Ministry of Health and Wellness, Gaborone, Botswana.
FAU - Dare, Kunle
AU  - Dare K
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Gaborone, Botswana.
FAU - Odoyo-June, Elijah
AU  - Odoyo-June E
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Nairobi, Kenya.
FAU - Soo, Leonard
AU  - Soo L
AD  - U.S. Agency for International Development, Nairobi, Kenya.
FAU - Toti-Mokoteli, Likabelo
AU  - Toti-Mokoteli L
AD  - Ministry of Health, Maseru, Lesotho.
FAU - Manda, Robert
AU  - Manda R
AD  - U.S. Agency for International Development, Maseru, Lesotho.
FAU - Kapito, Martin
AU  - Kapito M
AD  - Ministry of Health, Lilongwe, Malawi.
FAU - Msungama, Wezi
AU  - Msungama W
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Lilongwe, Malawi.
FAU - Odek, James
AU  - Odek J
AD  - U.S. Agency for International Development, Lilongwe, Malawi.
FAU - Come, Jotamo
AU  - Come J
AD  - Ministry of Health, Maputo, Mozambique.
FAU - Canda, Marcos
AU  - Canda M
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Maputo, Mozambique.
FAU - Gaspar, Nuno
AU  - Gaspar N
AD  - U.S. Agency for International Development, Maputo, Mozambique.
FAU - Mekondjo, Aupokolo
AU  - Mekondjo A
AD  - Ministry of Health and Social Services, Windhoek, Namibia.
FAU - Zemburuka, Brigitte
AU  - Zemburuka B
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Windhoek, Namibia.
FAU - Bonnecwe, Collen
AU  - Bonnecwe C
AD  - National Department of Health, Pretoria, South Africa.
FAU - Vranken, Peter
AU  - Vranken P
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Pretoria, South Africa.
FAU - Mmbando, Susan
AU  - Mmbando S
AD  - Ministry of Health, Dar es Salaam, Tanzania.
FAU - Simbeye, Daimon
AU  - Simbeye D
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Dar es Salaam, Tanzania.
FAU - Rwegerera, Fredrick
AU  - Rwegerera F
AD  - U.S. Agency for International Development, Dar es Salaam, Tanzania.
FAU - Wamai, Nafuna
AU  - Wamai N
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Kampala, Uganda.
FAU - Kyobutungi, Shelia
AU  - Kyobutungi S
AD  - U.S. Agency for International Development, Kampala, Uganda.
FAU - Zulu, James Exnobert
AU  - Zulu JE
AD  - Ministry of Health, Lusaka, Zambia.
FAU - Chituwo, Omega
AU  - Chituwo O
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Lusaka, Zambia.
FAU - Xaba, Sinokuthemba
AU  - Xaba S
AD  - Ministry of Health and Child Care, Harare, Zimbabwe.
FAU - Mandisarisa, John
AU  - Mandisarisa J
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Harare, Zimbabwe.
FAU - Toledo, Carlos
AU  - Toledo C
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
LA  - eng
GR  - 001/WHO_/World Health Organization/International
PT  - Journal Article
DEP - 20210212
PL  - England
TA  - BMC Urol
JT  - BMC urology
JID - 100968571
SB  - IM
MH  - Adolescent
MH  - Africa
MH  - Child
MH  - Circumcision, Male/*adverse effects
MH  - Cutaneous Fistula/epidemiology/*etiology
MH  - HIV Infections/prevention & control
MH  - Humans
MH  - Male
MH  - Postoperative Complications/epidemiology/*etiology
MH  - Retrospective Studies
MH  - Time Factors
MH  - Urethral Diseases/epidemiology/*etiology
MH  - Urinary Fistula/epidemiology/*etiology
PMC - PMC7881669
OTO - NOTNLM
OT  - Fistula
OT  - HIV
OT  - Intraoperative complications
OT  - Male circumcision
COIS- The authors declare that they have no competing interests.
EDAT- 2021/02/14 06:00
MHDA- 2021/07/23 06:00
PMCR- 2021/02/12
CRDT- 2021/02/13 05:34
PHST- 2020/10/15 00:00 [received]
PHST- 2021/02/01 00:00 [accepted]
PHST- 2021/02/13 05:34 [entrez]
PHST- 2021/02/14 06:00 [pubmed]
PHST- 2021/07/23 06:00 [medline]
PHST- 2021/02/12 00:00 [pmc-release]
AID - 10.1186/s12894-021-00790-y [pii]
AID - 790 [pii]
AID - 10.1186/s12894-021-00790-y [doi]
PST - epublish
SO  - BMC Urol. 2021 Feb 12;21(1):23. doi: 10.1186/s12894-021-00790-y.