Prevalence of preoperative penile abnormalities among voluntary male medical circumcision patients in Swaziland.
BACKGROUND
Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughout the country. During many of these circumcisions, genital medical conditions and penile abnormalities are simultaneously discovered and corrected.


PURPOSE
The goal of our study was to evaluate the prevalence of penile abnormalities discovered and treated during voluntary male medical circumcisions performed by The Luke Commission (TLC) throughout rural Swaziland.


BASIC PROCEDURES
We completed a retrospective analysis of all male patients who underwent voluntary male medical circumcision performed by TLC during a period from June-August, 2014. The penile abnormalities included: phimosis, paraphimosis, epispadias, hypospadias, ulcers, balanitis, torsion, and foreskin adherent to the glans.


MAIN FINDINGS
Of 929 total circumcisions, 771 (83%) patients had at least one pre-existing penile abnormality identified during their examinations and procedures, totaling 1110 abnormalities. Three specific abnormalities were detected - phimosis, adherent foreskin, and hypospadias. The 6-12 and 13-19 age groups had adequate sample sizes to yield precise estimates of prevalence (age group 6-12: 87% (95% confidence interval [CI]=84-90%; age group 13-19: 79% (95% CI=74-84%).


PRINCIPLE CONCLUSIONS
The Luke Commission is improving the lives of children and adults with limited access to healthcare through regular preoperative evaluations during male circumcision, and the organization is setting an example for other international healthcare groups.


LEVEL OF EVIDENCE
Type of Study: Prognostic Study, Level II.
['Oddo|Anthony R|AR|', 'Ruedrich|Elizabeth|E|', 'Zust|Christopher|C|', 'Marugg|Lindsey|L|', 'VanderWal|Echo|E|', 'VanderWal|Harry|H|', 'Sartori|Rebekah|R|', 'Markert|Ronald|R|', 'McCarthy|Mary C|MC|']
D000293:Adolescent D000328:Adult D002648:Child D002675:Child, Preschool D002944:Circumcision, Male D003430:Cross-Sectional Studies D013541:Eswatini D006801:Humans D008297:Male D008875:Middle Aged D010409:Penile Diseases D010413:Penis D057234:Preoperative Period D015995:Prevalence D012189:Retrospective Studies D012424:Rural Population D035141:Voluntary Programs D055815:Young Adult
Penile abnormalities Circumcision Swaziland HIV