Table Of ContentSurgical Guide to Circumcision
David A. Bolnick (cid:129) Martin Koyle
Assaf Yosha
Editors
Surgical Guide
to Circumcision
Editors
David A. Bolnick, Ph.D. Assaf Yosha, M.D.
Department of Urology Department of Family Medicine
University of Washington – Seattle University of Rochester
Children’s Hospital Rochester, NY
Seattle, WA USA
USA
Martin Koyle, M.D.
Department of Surgery
University of Toronto
Toronto, ON
Canada
Department of Pediatric Urology
Hospital for Sick Children
Toronto, ON
Canada
ISBN 978-1-4471-2857-1 ISBN 978-1-4471-2858-8 (eBook)
DOI 10.1007/978-1-4471-2858-8
Springer Dordrecht Heidelberg New York London
Library of Congress Control Number: 2012939624
© Springer-Verlag London 2012
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material
supplied specifically for the purpose of being entered and executed on a computer system, for
exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is
permitted only under the provisions of the Copyright Law of the Publisher’s location, in its
current version, and permission for use must always be obtained from Springer. Permissions for
use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable
to prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Foreword
This volume is being written at the same time as the independent production
of statements by both the American Academy of Pediatrics and the Center for
Disease Control regarding circumcision, its ef fi cacy, and advisability. I fi rst
became embroiled in the circumcision debate in 1971 when I was interviewed
by a reporter from the Chicago Tribune following the report of the Task Force
of the AAP that stated “there is no medical indication for routine circumci-
sion.” Shortly thereafter I was asked to write a monograph about circumci-
sion, its methodology, and complications. The research that I did in preparing
that piece convinced me that there probably is no procedure that has produced
as much emotion and rhetoric as circumcision.
Twenty fi ve years later I was appointed a member of the AAP Task Force
on Circumcision that produced its report in 1999. By then, there was some
evidence that urinary infections in infants were less frequent after circumci-
sion and that penile cancer was less frequent as well. For that reason the state-
ment that was prepared did not recommend routine circumcision nor did it
condemn newborn circumcision. However, the rhetoric that surrounded those
deliberations and even more vociferously following the report is, in my opin-
ion, truly astounding.
Since that time there is solid evidence that the incidence of HIV infections,
other sexually transmitted diseases, and human papilloma virus carriage rates
are all substantially reduced after circumcision. Is that reason enough to rec-
ommend routine newborn circumcision? For those who are strongly opposed
to circumcision whether for cultural reasons, xenophobic reasons, fi nancial
reasons, or blind bias, I am sure the answer will be a resounding NO!
Because there is increased evidence that circumcision does provide some
small but de fi nite health advantages, the debate will continue. This volume
has attempted to produce a balanced view of the subject. The chapter authors
have been prominent on both sides of the debate. Only time will tell whether
this volume will help to settle the ongoing arguments or perhaps only further
stoke the fi res of passion and debate.
CA , USA George Kaplan , M.D.
v
About the Authors
Award, seven Telly Awards, California Governor’s
Media Access Award, Easter Seals’ Special EDI
Award, two Aurora Awards, AEGIS Award of
Excellence, and many others. From 1973,
Bolnick’s early research interest was in coronary
artery fl ow dynamics followed by vision and reti-
nal physiology. In 1984 he completed his Ph.D.
in physiology with a focus on photoreceptor
physiology at the University of California, Davis.
From 1984 to 1988 Dr. Bolnick undertook post-
doctoral studies in photoreceptor membrane bio-
physics at the University of California, San
Francisco. Bolnick switched from basic research
to computers/software and in 1990 took a posi-
tion at Microsoft for the following 10 years.
There he designed software, helped redesign
software for use by people with disabilities,
served on federal committees on accessible
technology compliance, and testi fi ed before the
US Senate, the US House of Representatives,
and the Federal Communications Commission
on accessible technology for people with dis-
David A. Bolnick
abilities. Currently, Dr. Bolnick is co-owner of
a small media production company and is direc-
Dr. Bolnick is an amalgam of scholar, scientist, tor of its medical media division, M edicoLens.
technology design guru, media producer, and com . In addition, he has served the Paci fi c
photographer. Bolnick’s contributions have been Northwest Jewish community as a certi fi ed
recognized by numerous achievement awards mohel (Jewish ritual circumciser) for nearly a
including seven US Patents (most recent, March quarter century. Dr. Bolnick is an af fi liate fac-
2010), United Nations Outstanding Achievement ulty in the Department of Urology, University
Award, US Vice President Gore’s Hammer of Washington, Seattle.
vii
viii About the Authors
Seattle Children’s Hospital (2008–2011). During
his almost three decades in academic urology,
Dr. Koyle has been known for his multiple inno-
vations and contributions to the fi elds of pediatric
urology and transplantation. He was the fi rst
to publish on laparoscopic nephrectomy in
infants, introduced the MACE (Malone Antegrade
Continence Enema), the Bianchi technique (single
incision orchidopexy), and the Bracka hypospadias
repair to North America, and also one of the fi rst
surgeons to gain experience in the tubularized
incised urethral plate hypospadias repair (Snodgrass
technique) and to demonstrate its applicability
beyond North America to Europe and Asia. He
invented and patented the Koyle stent (Cook Inc),
which is used around the world for hypospadias
and urethral surgery. To date, he has contributed
over 200 major publications and chapters to the
literature. Recently he has been a co-editor to the
textbooks, P ediatric Urology – Surgical
Complications and Management and Guide to
Martin Koyle
Pediatric Urology and Surgery in Clinical
Practice . He is Associate Editor of D ialogues in
Martin Koyle is a pediatric urologist, currently Pediatric Urology and serves on the editorial
living in Toronto, Canada. There he serves as boards of P ediatric Surgery International and the
Professor of Surgery and Program Director, Journal of Pediatric Urology . Dr. Koyle is past
Pediatric Urology at the University of Toronto president of the Rocky Mountain Urology
and the Hospital for Sick Children. After grow- Society, the Society for Pediatric Urology, and
ing up in Canada where he received his medical the American Association of Pediatric Urologists.
degree (1976), he trained in surgery at Los He is a Fellow of the American College of
Angeles County+USC Medical Center and in Surgeons, Fellow of the American Academy of
urology at Harvard Program centered at the Pediatrics, and Fellow of the Society for Pediatric
Brigham and Women’s Hospital in Boston Urology. In January, 2010, he was elected “on
(1980–1984). He then advanced through aca- merit” as Fellow of the Royal College of Surgeons
demic posts at UCLA (1984–1989), University for his contributions to urology, pediatric surgery,
of Colorado, and The Children’s Hospital (1989– and pediatric urology internationally, and in par-
2008), and the University of Washington and ticular in the British Isles.
About the Authors ix
He is skilled in operative obstetrics and cares for
common high risk perinatal conditions. His focus
throughout his career has been to provide inner-
city underserved residents access to quality
healthcare. Dr. Yosha attended Albany Medical
College and in 2005 completed his Family
Medicine training at NY-Presbyterian Hospital,
Columbia . He then spent a year working in tan-
dem with his wife in rural New Zealand and
at Indian Health Service facilities in America.
In 2007 Dr. Yosha completed an Obstetrics
Fellowship training program for family physi-
cians in Seattle, WA, where he established a cir-
cumcision clinic which included resident
physician training. Now, as a Senior Instructor at
the University of Rochester, in the Highland
Family Medicine Department, Dr. Yosha teaches
residents in the three common circumcision tech-
Assaf Yosha niques. Besides good technique and cosmetic out-
come, he is always aiming to perform and teach a
painless procedure with minimal anxiety to the
Dr. Assaf Yosha is known for his emphasis on parents. Dr. Yosha also serves the greater
patient and community centered care. He is a fam- Rochester region as a mohel to reform and con-
ily physician at the Woodward Health Center, a servative families. In his spare time he enjoys run-
Community Health Center that is part of the ning, watching fi lms, and spending time with his
Anthony Jordan Health Center in Rochester, NY. wife and young daughters.
