Urethral transection following neonatal circumcision using a Plastibell device.

A five-year-old male child presented with a large fistula in the coronal region. The mother gave history of a Plastibell device being applied in the newborn nursery and the child subsequently voiding from the coronal region. Clinical examination revealed an abnormally large meatus with a small glans bridge and a small suture around it. In the coronal region, the ventral half of the urethra was transected across. Although urethral injuries are not unknown following the use of the Plastibell device,[12] we feel this amount of urethral damage is most unusual. It could only be explained by assuming that the child had the ‘Megameatus Intact Prepuce’ variant of hypospadias, and the suture on the Plastibell device had perhaps slipped and cut through the thin urethra in the coronal region. However, the small retained suture around the glans bridge could not be explained. This image adds another reason for advising caution before using the Plastibell device in the penis of a newborn, without careful clinical examination [Figure 1].

Figure 1

Appearance of phallus after circumcision