|Year : 2013 | Volume
| Issue : 3 | Page : 113-114
Petroleum jelly for prevention of post-circumcision meatal stenosis
Sameer Y Al-Abdi
Consultant Neonatologist, Neonatal Division, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
|Date of Web Publication||18-Oct-2013|
Sameer Y Al-Abdi
Consultant Neonatologist, Neonatal Division, King Abdulaziz Hospital, Al-Ahsa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Abdi SY. Petroleum jelly for prevention of post-circumcision meatal stenosis. J Clin Neonatol 2013;2:113-4
| Context|| |
Post-circumcision meatal stenosis (PCMS) is well-recognized late complication of circumcision performed during diaper age.  Accordingly, rubbing between circumcised site and the diaper is one of plausible causes of PCMS. Most of PCMS are corrected surgically (meatotomy) under general anesthesia.  Bazmamoun, et al., aimed to evaluate the hypothesis that lubricating the circumcision site would reduce the incidence of PCMS.
| Materials and Methods|| |
A single-center randomized controlled trial (RCT) on boys younger than 2-years-old referred to an Iranian hospital for circumcision between 2006 and 2007. The boys were randomized into two groups: The intervention group in which parents applied petroleum jelly on glans and meatal area after each diaper change for 6 months post-circumcision and the control group in which parents were instructed not to apply any lubricant on circumcised sites. All circumcisions were performed by the same surgeon according to the sleeve method. Gentamicin-soaked gauze was applied on circumcision site in both groups. Boys in both groups were evaluated for 6 months: Every alternate day for the first 2 weeks; then weekly for 1 month, and then bi-weekly.
A sample size calculation revealed that 200 boys would be required for each group. Four hundred boys younger than 2-years-old enrolled, but six (three in each group) were excluded from the analysis because of poor follow-up compliance.
Boys younger than 2-years-old.
Petroleum jelly on glans and meatal area after each diaper change for 6 months.
- Infection of the circumcision site.
- Post-circumcision bleeding.
- Time of recovery.
| Results|| |
Results are shown as follows in [Table 1].
| Commentary|| |
This RCT scored 5 out of 5 on the Jadad scale as the double blinding was not feasible.  It showed that the petroleum jelly was effective for preventing the PCMS with a number to treat of 15 (95% confidence interval: 9, 30). The petroleum jelly reduced risk of post-circumcision infection and bleeding. The petroleum jelly nearly halved the recovery time of the circumcision sites. However, a robust definition of post-circumcision infection, bleeding, and recovery time was not provided. It seems that age of the study boys and recovery time of circumcision site were not normally distributed or there were outliers as 2 standard deviation (SD) below the means would yield unrealistic data. Accordingly, it would have been more appropriate to represent these two variables as the median with range or interquartile range instead of the mean (SD). A nonparametric test would be more appropriate for these two variables than the parametric t-test. Moreover, several online two sample t-test calculators yielded a P < 0.0001 for the difference between means of recovery time, which is much smaller than the reported P value (0.03). In summary, this RCT demonstrated that an easy, safe, cheap, widely available intervention (petroleum jelly) reduces some of early and late complications of circumcision. It is prudent to apply the petroleum jelly on glans and meatal area of circumcised boys after each diaper change for 6 months post-circumcision.
Bazmamoun H, Ghorbanpour M, Mousavi-Bahar SH. Lubrication of circumcision site for prevention of meatal stenosis in children younger than 2 years old. Urology journal. 2008;5 (4):233-6. Epub 2008/12/23.
| References|| |
|1.||Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urol 2010;10:2. |
|2.||Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) 2006;45:49-54. |
|3.||Jadad AR, Enkin MW. Randomized controlled trials: Questions, answers and musings. 2 nd ed. Malden, Massachusetts: USA: Blackwell Publishing, Inc.; 2007. |