The complications of this procedure may lead to severe genital mutilation with partial or complete penile loss and may even result in mortality. In a study by Meissner and Buso conducted in the Eastern Cape from 2001 to 2005 there were 1748 hospital admissions, 107 genital mutilations and 177 deaths caused by ritual circumcision. Septicaemia, pneumonia and dehydration were the most common causes of death. The extent of genital mutilation varied from partial loss of the glans or distal penile shaft and urethra, to complete loss of the penis due to gangrene. Less common complications of ritual circumcision include polyarticular septic arthritis. The complication rates of ritual circumcision are much higher than those reported for infant and neonatal circumcision (1-7%) where the complications are mostly minor and almost never result in penile loss However, in a systematic review of the literature Wilcken et al found that the acquisition of data from the ritual circumcision studies was often poor, as only 11 of 1639 articles reviewed were suitable for analysis. Other causes of penile loss include electrical burns, self-mutilation and shotgun wounds. These aetiologies are rare in South Africa in contrast to the large numbers of ritual circumcision related penile amputees.