{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:00:26Z","timestamp":1781632826807,"version":"3.54.5"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Keloids are rare but challenging complications in penile surgeries, including circumcision. The President\u2019s Emergency Plan for AIDS Relief (PEPFAR) supports voluntary medical male circumcisions (VMMC) for HIV prevention in sub-Saharan Africa, and has monitored major adverse events through its Notifiable Adverse Event Reporting system (NAER) since 2015, providing unique opportunities to understand keloid epidemiology and risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All 2015\u20132023 NAER keloid cases were reviewed. Variables abstracted included age at VMMC, time course, and case characteristics. Descriptive analysis and Fisher\u2019s exact test of the association between client age (&lt;\u200915\u00a0years vs.\u2009\u2265\u200915\u00a0years) and keloids were performed. Systematic literature searches were also conducted on case reports, outcomes and management guidelines, to produce a narrative summary and comparisons between the NAER cases and prior literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven cases were reported. Clients were\u2009&lt;\u200915\u00a0years old in 10\/11, with median age 12\u00a0years and mean time to diagnosis 1.8\u00a0years. Clients aged 10\u201314\u00a0years had a significantly higher risk for keloids compared to those aged 15 and older (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004). Case characteristics were similar to those in prior case series, as was management, except that silicone gels or sheeting were not used. Follow-up was too brief to assess outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Keloids were a rare complication of PEPFAR-supported VMMCs. Keloids were strongly associated with age 10\u201314\u00a0years at circumcision as compared to older age. Programs can remind clients to return to VMMC sites even for late complications, and develop expert referral networks. Silicone gels or sheeting could represent an additional conservative management option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12894-025-01949-7","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:54:24Z","timestamp":1768571664000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Keloids as a rare complication of voluntary medical male circumcision: findings from PEPFAR\u2019s notifiable adverse events reporting system"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4878-9701","authenticated-orcid":false,"given":"Stephanie","family":"Davis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eniko","family":"Akom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerian","family":"Kiggundu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Nabukera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daimon","family":"Simbeye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Ernest","family":"Rwabiyago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan","family":"Mmbando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alick","family":"Kayange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neway","family":"Fida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Mandisarisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tungamirai","family":"Mhuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wezi","family":"Msungama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kapito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustin","family":"Matchere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Maulidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah","family":"Odoyo-June","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Soo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrose","family":"Juma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Lucas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"issue":"9562","key":"1949_CR1","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/S0140-6736(07)60312-2","volume":"369","author":"RC Bailey","year":"2007","unstructured":"Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643\u201356. https:\/\/doi.org\/10.1016\/S0140-6736(07)60312-2.","journal-title":"Lancet"},{"issue":"11","key":"1949_CR2","doi-asserted-by":"publisher","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","volume":"2","author":"B Auvert","year":"2005","unstructured":"Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005;2(11):e298. https:\/\/doi.org\/10.1371\/journal.pmed.0020298. Epub 2005 Oct 25. Erratum in: PLoS Med. 2006 May;3(5):e298. PMID: 16231970; PMCID: PMC1262556.","journal-title":"PLoS Med"},{"issue":"9562","key":"1949_CR3","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/S0140-6736(07)60313-4","volume":"369","author":"RH Gray","year":"2007","unstructured":"Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657\u201366. https:\/\/doi.org\/10.1016\/S0140-6736(07)60313-4. PMID: 17321311.","journal-title":"Lancet"},{"key":"1949_CR4","unstructured":"The urgency of now: AIDS at a crossroads. Geneva: Joint United Nations Programme on HIV\/AIDS; 2024. Licence: CC BY-NC-SA 3.0 IGO. hhttps:\/\/www.unaids.org\/en\/resources\/documents\/2024\/global-aids-update-2024."},{"key":"1949_CR5","unstructured":"Voluntary medical male circumcisions. PEPFAR Panorama Spotlight, Prevention dossier. https:\/\/spotlight.pepfar-panorama.org\/. Accessed 26 Dec 2024."},{"issue":"6","key":"1949_CR6","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1007\/s11904-022-00636-8","volume":"19","author":"T Lucas","year":"2022","unstructured":"Lucas T, Cooney C, Prainito A, Godfrey C, Kiggundu V, Thomas AG, et al. Consolidated overview of notifiable adverse events in the U.S. president\u2019s emergency plan for AIDS relief\u2019s voluntary medical male circumcision program through 2020. Curr HIV AIDS Rep. 2022;19(6):508\u201315. https:\/\/doi.org\/10.1007\/s11904-022-00636-8.","journal-title":"Curr HIV AIDS Rep"},{"issue":"11","key":"1949_CR7","doi-asserted-by":"publisher","first-page":"337","DOI":"10.15585\/mmwr.mm6711a6","volume":"67","author":"LE Hinkle","year":"2018","unstructured":"Hinkle LE, Toledo C, Grund JM, et al. Bleeding and blood disorders in clients of voluntary medical male circumcision for HIV prevention - Eastern and Southern Africa, 2015\u20132016. MMWR Morb Mortal Wkly Rep. 2018;67(11):337\u20139. https:\/\/doi.org\/10.15585\/mmwr.mm6711a6. PMID: 29565839; PMCID: PMC5868201.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"1949_CR8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12894-021-00790-y","volume":"21","author":"T Lucas","year":"2021","unstructured":"Lucas T, Hines JZ, Samuelson J, et al. Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention-15 African countries, 2015\u20132019. BMC Urol. 2021;21(1):23. https:\/\/doi.org\/10.1186\/s12894-021-00790-y. PMID: 33579261; PMCID: PMC7881669.","journal-title":"BMC Urol"},{"issue":"1","key":"1949_CR9","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12894-020-00613-6","volume":"20","author":"TJ Lucas","year":"2020","unstructured":"Lucas TJ, Toledo C, Davis SM, et al. Case series of glans injuries during voluntary medical male circumcision for HIV prevention - eastern and southern Africa, 2015\u20132018. BMC Urol. 2020;20(1):45. https:\/\/doi.org\/10.1186\/s12894-020-00613-6. PMID: 32334596; PMCID: PMC7183662.","journal-title":"BMC Urol"},{"issue":"5","key":"1949_CR10","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1111\/iwj.12163","volume":"12","author":"HR Ozakpinar","year":"2015","unstructured":"Ozakpinar HR, Sari E, Horoz U, et al. Keloid of the circumcision scar: a rare complication. Int Wound J. 2015;12(5):611\u20132. https:\/\/doi.org\/10.1111\/iwj.12163.","journal-title":"Int Wound J"},{"issue":"2","key":"1949_CR11","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1111\/wrr.13157","volume":"32","author":"FC Isoldi","year":"2024","unstructured":"Isoldi FC, Garcia A, Vieites L, et al. Keloids in male genitalia-systematic review and illustrative case report. Wound Repair Regen. 2024;32(2):171\u201381. https:\/\/doi.org\/10.1111\/wrr.13157.","journal-title":"Wound Repair Regen"},{"issue":"1","key":"1949_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004052","volume":"10","author":"HIA Alzeerelhouseini","year":"2022","unstructured":"Alzeerelhouseini HIA, Alzaro R. The role of plastic surgery in the treatment of recurrent and large penile keloid. Plast Reconstr Surg. 2022;10(1):e4052. https:\/\/doi.org\/10.1097\/GOX.0000000000004052.","journal-title":"Plast Reconstr Surg"},{"key":"1949_CR13","volume-title":"WHO technical advisory group on innovations in male circumcision, 2014","author":"World Health Organization","year":"2015","unstructured":"World Health Organization. WHO technical advisory group on innovations in male circumcision, 2014. Geneva: World Health Organization; 2015."},{"key":"1949_CR14","doi-asserted-by":"publisher","unstructured":"Davis SM, Hines JZ, Habel M, et al. Progress in voluntary medical male circumcision for HIV prevention supported by the US President\u2019s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data. BMJ Open. 2018;8:e021835. https:\/\/doi.org\/10.1136\/bmjopen-2018-021835.","DOI":"10.1136\/bmjopen-2018-021835"},{"key":"1949_CR15","doi-asserted-by":"publisher","unstructured":"Peck ME, Ong K, Lucas T, Thomas AG, Wandira R, Ntwaaga B, et al. Preventing HIV among adolescent boys and young men through PEPFAR-supported voluntary medical male circumcision in 15 Sub-Saharan African countries, 2018-2021. AIDS Educ Prev. 2023;35:67-81. https:\/\/doi.org\/10.1521\/aeap.2023.35.suppA.67. PMID: 37406146; PMCID:PMC11002756.","DOI":"10.1521\/aeap.2023.35.suppA.67"},{"issue":"1","key":"1949_CR16","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1186\/s13104-017-2845-9","volume":"10","author":"M Galukande","year":"2017","unstructured":"Galukande M, Nakaggwa F, Busisa E, et al. Long term post prepex male circumcision outcomes in an urban population in Uganda: a cohort study. BMC Res Notes. 2017;10(1):522. https:\/\/doi.org\/10.1186\/s13104-017-2845-9.","journal-title":"BMC Res Notes"},{"issue":"6","key":"1949_CR17","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.jpurol.2022.03.014","volume":"18","author":"JM Lovin","year":"2022","unstructured":"Lovin JM, Stone KM, Pickett JK, et al. Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys. J Pediatr Urol. 2022;18(6):790\u20135. https:\/\/doi.org\/10.1016\/j.jpurol.2022.03.014.","journal-title":"J Pediatr Urol"},{"issue":"14","key":"1949_CR18","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.3760\/cma.j.issn.0376-2491.2016.14.014","volume":"96","author":"JQ Zhang","year":"2016","unstructured":"Zhang JQ, Liu JH, Jin LC, et al. [A new device for removing shang ring after circumcision (a report of 257 cases)]. Zhonghua Yi Xue Za Zhi. 2016;96(14):1128\u201330. https:\/\/doi.org\/10.3760\/cma.j.issn.0376-2491.2016.14.014.","journal-title":"Zhonghua Yi Xue Za Zhi"},{"issue":"10","key":"1949_CR19","doi-asserted-by":"publisher","first-page":"1879","DOI":"10.3760\/cma.j.issn.0366-6999.20133135","volume":"127","author":"Y Cheng","year":"2014","unstructured":"Cheng Y, Wu K, Yan Z, et al. Long-term follow-up for Shang Ring male circumcision. Chin Med J. 2014;127(10):1879\u201383.","journal-title":"Chin Med J"},{"issue":"4","key":"1949_CR20","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1590\/S1677-55382013000400558","volume":"39","author":"JMB Netto","year":"2013","unstructured":"Netto JMB, de Araujo JJG, de Almeida Noronha MF, et al. A prospective evaluation of plastibell circumcision in older children. Int Braz J Urol. 2013;39(4):558\u201364. https:\/\/doi.org\/10.1590\/S1677-55382013000400558.","journal-title":"Int Braz J Urol"},{"issue":"1","key":"1949_CR21","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.1038\/s41598-022-20140-8","volume":"13","author":"CH Chen","year":"2023","unstructured":"Chen CH, Cheng WM, Fan YH, et al. Factors influencing satisfaction with male circumcision in Taiwan. Sci Rep. 2023;13(1):2313. https:\/\/doi.org\/10.1038\/s41598-022-20140-8.","journal-title":"Sci Rep"},{"key":"1949_CR22","doi-asserted-by":"publisher","unstructured":"Fahmy MAB. Nonaesthetic circumcision scarring. In: Complications in male circumcision. 2019. p. 99\u2013134. https:\/\/doi.org\/10.1016\/B978-0-323-68127-8.00010-7.","DOI":"10.1016\/B978-0-323-68127-8.00010-7"},{"issue":"4","key":"1949_CR23","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/s00238-008-0319-y","volume":"32","author":"JP Stromps","year":"2009","unstructured":"Stromps JP, Kolios G, Cedidi CC. Hypertrophic scar and keloid formation after male circumcision - a case report. Eur J Plast Surg. 2009;32(4):213\u20135. https:\/\/doi.org\/10.1007\/s00238-008-0319-y.","journal-title":"Eur J Plast Surg"},{"key":"1949_CR24","doi-asserted-by":"publisher","DOI":"10.1111\/pde.15473","author":"I Tam","year":"2023","unstructured":"Tam I, Sun L, Patel A, et al. Penile keloid formation post-circumcision: a case series and review of literature. Pediatr Dermatol. 2023. https:\/\/doi.org\/10.1111\/pde.15473.","journal-title":"Pediatr Dermatol"},{"issue":"1","key":"1949_CR25","doi-asserted-by":"publisher","first-page":"48.e1","DOI":"10.1016\/j.jpurol.2018.08.003","volume":"15","author":"F Alyami","year":"2019","unstructured":"Alyami F, Ferandez N, Koyle MA, et al. (2020) Keloid formation after pediatric male genital surgeries: an uncommon and difficult problem to manage. J Pediatr Urol. 2019;15(1):48.e1-48.e8. https:\/\/doi.org\/10.1016\/j.jpurol.2018.08.003. Comment in: J Urol. 204(4):866 PMID: 32701008.\u00a0https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/32701008.","journal-title":"J Pediatr Urol"},{"issue":"3","key":"1949_CR26","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/j.jpurol.2011.02.013","volume":"7","author":"DM Bermudez","year":"2011","unstructured":"Bermudez DM, Canning DA, Liechty KW. Age and pro-inflammatory cytokine production: wound-healing implications for scar-formation and the timing of genital surgery in boys. J Pediatr Urol. 2011;7(3):324\u201331. https:\/\/doi.org\/10.1016\/j.jpurol.2011.02.013.","journal-title":"J Pediatr Urol"}],"container-title":["BMC Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12894-025-01949-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12894-025-01949-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12894-025-01949-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:45:05Z","timestamp":1781631905000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12894-025-01949-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1949"],"URL":"https:\/\/doi.org\/10.1186\/s12894-025-01949-7","relation":{},"ISSN":["1471-2490"],"issn-type":[{"value":"1471-2490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]},"assertion":[{"value":"30 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients provided informed written consent for the procedure; consent for minors was obtained from parents or guardians and adhered to national standards. This project was reviewed by CDC\u2019s Scientific Integrity Branch and determined not to constitute research; therefore the Helsinki Declaration therefore does not apply. No experimental procedures or data collection for research purposes were performed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. Patient data is not individual details, but a limited set of prespecified abstracted data fields for which all patients would have values.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}