# Outcomes of Complex Circumcisions for Pre-cancerous and Cancerous Penile Lesions at a Tertiary Referral Centre: A Retrospective Cohort Study

## TL;DR

This study examines complication rates of complex circumcisions for penile cancer and pre-cancerous conditions, finding a low overall risk with most complications being minor.

## Contribution

The study provides a UK-based evidence base on complication rates and predictors in complex circumcisions for penile lesions.

## Key findings

- Overall complication rate was 11%, with infections and altered glans sensation being most common.
- Consultant-performed procedures had higher complication rates (14%) compared to trainees (2.3%).
- No significant associations were found between complications and factors like age or cancer stage.

## Abstract

Objective: This study aimed to evaluate the complication rates of complex circumcisions performed for penile cancer, penile intra-epithelial neoplasia (PeIN) and severe lichen sclerosus, and to identify any predictors of post-operative complications.

Patients and methods: A retrospective cohort study was conducted at a tertiary urology referral centre. Records of 191 male patients who underwent complex circumcisions between 2014 and 2020 were reviewed. Complex circumcision was defined as circumcision for cancerous or pre-cancerous lesions, condyloma or severe lichen sclerosus with >50% adherence to the glans. Patient demographics, indications, surgical variables and complications were analysed. Complications were graded using the Clavien-Dindo classification.

Results: The overall complication rate was 11%. The most common complications were infection (n = 5) and altered glans sensation (n = 5). Consultant-performed procedures had a significantly higher complication rate (14%) compared to those performed by trainees (2.3%) (p = 0.05), likely reflecting case complexity. No statistically significant associations were found between complications and patient age, indication, cancer stage or grade, type of circumcision or suture technique. All complications were Clavien-Dindo Grade I or II, and there were no readmissions.

Conclusion: Complex adult circumcisions carry a modest complication risk, particularly in oncological cases. While consultant-led procedures had higher complication rates, this likely reflects the referral of more complex pathology. These findings provide a UK-based evidence base for consenting patients undergoing circumcision for malignant or pre-malignant indications.