Introduction: Approximately a third of men worldwide and over 90% of Israeli men are circumcised. The procedure carries a low rate of complication, mainly including surgical and infectious complications. Urinary tract obstruction (UTO) is a rare complication of circumcision.
Aims: The aim of this study was to define the incidence of UTO following circumcision in the last 20 years and describe the characteristics of the affected babies.
Methods: Study participants were identified from a list consisting of all male babies aged 7-30 days treated at the Shaare Zedek Medical Center during the years 2000-2020. Files of patients with serum creatinine ≥ 1 mg/dl were reviewed. Clinical and laboratory data were collected from patients' records.
Results: Ten babies with acute kidney injury due to UTO after circumcision were identified. Average age at admission was 10.1 days (8-13). Only two babies had an uncomplicated postnatal course. The main findings on physical examination were distended abdomen, abdominal wall discoloration and leg edema. Average creatinine on admission was 1.76 mg/dl (1.0-3.28). Additional findings were hyperkalemia 6.2 mEq/L (4.5-7.6) and hyponatremia 125 mEq/L (118-134). All hospitalized patients developed post-obstructive diuresis. Kidney function and laboratory abnormalities completely resolved in all of our patients. There was no evidence of kidney damage in six children with long-term follow up.
Conclusions: UTO with acute kidney injury is a rare severe complication of circumcision. Prompt identification and proper treatment can result in complete resolution of kidney function.