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PD16-01 FILLING THE GAPS IN NEONATAL CIRCUMCISIONS: A UROLOGIC PHYSICIAN ASSISTANT NEONATAL CIRCUMCISION CLINIC OUTCOMES AND INCREASE REVENUE STREAM

INTRODUCTION AND OBJECTIVES: Neonatal circumcision rates in the United States vary and are as high as 71%. A recent survey of Society of Pediatric Urology members identified that 79.6% of responding pediatric urologists performing circumcisions perform < 5/week and those not performing neonatal circumcisions mostly cited time constraints as the limiting factor. 28.4% of responders felt there were an inadequate number of circumcision providers and 31% felt non-urology providers were not well-trained. We propose that Urologic Physician Assistants can be a valuable resource in performing neonatal circumcisions where skilled providers are deficient and serve as educators to those who want to enhance their skills. METHODS: A retrospective review of all infants evaluated for neonatal circumcision by a single pediatric urology Physician Assistant over a 3 year period was performed noting technique, age and weight at circumcision, presence/absence of genital anomalies, and complications. RESULTS: Three hundred and seventy male infants were evaluated for neonatal circumcision. Age at the time of evaluation ranged from 1 week to 13 weeks of age (average 7.8 weeks) and weight at the time of presentation ranged from 3.2 kilograms to 7.5 kilograms (average 5.2 kilograms). Ninety-five infants did not undergo neonatal circumcision, the most common reason being abnormal genital examination (n=90). Plastibell was utilized in 271 males and Gomco in 4 males. Complications included: return to emergency room, 4 patient (1.5%) and return to clinic in 10 patients (3.63%). Reasons for return visits included: retained Plastibell (5), penile swelling (4), penile adhesions (3), concerns regarding appearance (2) No patients experienced significant bleeding or required surgical intervention. CONCLUSIONS: Neonatal circumcision is commonly performed by non-urology providers. Complications related to neonatal circumcision are not infrequent with recent studies reporting that 4% of all visits to a pediatric urologist were for circumcision complications. Bleeding was reported in 1 % and infection in 0.4%. A retrospective review of 476 late complications of newborn circumcision identified that 40% were for inadequate circumcisions and another 5% for phimosis requiring revision. Our data supports that well-trained urology Physician Assistants can perform neonatal circumcision with low complication rates and increase office revenue in areas where demand for circumcision exceeds the current resources. Source of Funding: None