Circumcision and Meatal Stenosis of Boys with Bladder/Urethral Stones in a Hospital in Northern Ghana: Case Series

Abstract

Neonatal circumcision of boys is a common practice among people living in Northern Ghana. These case series included 22 boys between the ages of 17–60 months admitted to the pediatric emergency ward of a tertiary hospital. All the boys diagnosed with meatal stenosis (20/22) were circumcised within 14 weeks after birth, 1 of 22 had hypospadias with preputial hood with a pin-point meatus, and the other was not circumcised. Among the 22 cases, all presented with recurrent urinary tract infections (UTIs) with proteus (68.2%), Klebsiella species (22.7%), pseudomonas, and Serratia marcensis (4.5% respectively) isolated from urine cultures.  Routine abdomino-pelvic ultra-sound scans (kidney, ureter, bladder [KUB]) as well as ultrasound of the urethra and perineum were performed of which 13 of 22 children had stones in the bladder, 6 of 22 stones found in fossa navicularis, and 3 in the bulbar urethra. Meatal stenosis was a common finding among neonates after early circumcision and this needs to be made known as part of informed consent before neonatal circumcision. Surgically, a well-performed meatoplasty was carried out to correct it. In children whose stones were present in the bladder, these were fragmented and removed. More distal stones in the fossa navicularis were extracted after meatotomy. A delay in circumcision to later in life (at least 6 months after birth) is recommended as well as intensified educational programs on meatal stenosis, urinary tract infections, and blood borne infections in the communities since widespread neonatal circumcision is often carried out by “quacks doctors” (untrained native doctors). A balanced diet and adequate water intake will help prevent bladder or kidney stones formation.