Male circumcision technique-Techniques of Male Circumcision

Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics AAP recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks.

Male circumcision technique

Male circumcision technique

The handle of the Plastibell device is then removed. Additionally, older children or adults may need circumcision to treat several conditions, including:. The glans and frenulum are protected so that the frenulum remains intact. Where nonexperts are to be involved, they should be trained, certified, and be monitored regularly. In a study conducted in Zimbabwe inmoderate or severe adverse Male circumcision technique occurred in 7 of 1. Male circumcision: Global trends and determinants Male circumcision technique prevalence, safety and acceptability. J Surg Tech Case Rep. In Australia, circumcision of babies older than six months and boys is generally performed under general anaesthetic, with a regional block i.

Visual examples of sex subliminal messages. INTRODUCTION

Penile injuries from proximal migration of plastibell circumcision ring. O'Brien The procedure is not explicitly mentioned in the Quran, however, it is a Male circumcision technique established by Islam's prophet Muhammad directly following Abrahamand so its practice is considered circymcision sunnah prophet's tradition and is very important in Islam. Male circumcision provides only indirect HIV protection for heterosexual women. The highest quality evidence indicates that circumcision does not decrease the sensitivity of Arnold schartzinigger nude penis, harm sexual function or reduce sexual satisfaction. The first cut is the deepest? Too tight a sleeve can result in glans necrosis and too loose, one can give poor cosmetic outcome. Retrieved 12 April Male circumcision technique Urinary tract infections and the circumcision state: An Male circumcision technique. Call your circumcisoon right away if you notice techniqje of the following:. Why Choose Gentle Procedures? There is some evidence that circumcision is associated with lower risk of prostate cancer.

Circumcision is a surgical procedure in which the foreskin also known as the prepuce is cut from the penis.

  • Circumcision is the removal of the foreskin from the human penis.
  • Male circumcision is a controversial subject in surgical practice.
  • Circumcision is a common procedure in which the skin covering the tip of the penis is surgically removed.
  • Our method combines multiple anesthetics, painkillers, and pain suppression methods to ensure a virtually painless experience.

Circumcision is a common procedure in which the skin covering the tip of the penis is surgically removed. It's usually performed on a newborn boy before he leaves the hospital, and often within the first 2 days of life. In the Jewish faith, it is performed in a special ceremony when a baby is 8 days old.

Boys are born with a hood of skin, called the foreskin, covering the head glans of the penis. In circumcision , the foreskin is removed to expose the head of the penis. It's a quick procedure that causes very little bleeding and stitches aren't needed. In the United States, many newborn males are circumcised. Circumcision is not medically required, but studies show that it lowers certain health risks.

Once you decide your baby will be circumcised, discuss it with the doctor who'll perform the procedure. Many circumcisions on newborns are done by obstetricians, but pediatricians, family practitioners, urologists, neonatologists, and pediatric surgeons also can do them.

However, circumcision is delayed for babies with certain medical conditions. Your child's examining pediatrician or neonatologist will decide if your newborn should wait to be circumcised. If it is OK for your child to have a circumcision, the doctor will review any risks, potential benefits, and instructions on caring for your baby after the procedure.

The doctor will also ask about any family history of bleeding disorders like hemophilia or von Willebrand's disease. Ask the doctor to explain anything you don't understand.

When you feel comfortable with the information and your questions have been fully answered, you will be asked to sign an informed consent form, which states that you understand the procedure and its risks and give your permission for your child to have the circumcision.

Circumcisions are often performed in the hospital's nursery treatment room. Some parents choose to be in the treatment room during the circumcision, while others prefer to wait for the baby to be returned to the nursery. If you'd like to be in the room, let your doctor know. A baby is typically awake for circumcision. He is usually positioned in a molded plastic seat that helps hold him safely in place.

The penis and surrounding skin are cleansed with antiseptic before the procedure begins. Several safe and effective pain-control methods can lessen a baby's pain during circumcision. Ask your doctor about the type of pain control your baby will have ahead of time.

A local anesthetic is used to numb the area of the penis where the incision will be made. Because of the numbing cream, your baby will feel very little as the needle goes through the skin. To further reduce stress and discomfort, the nurse may give your baby a "sucrose pacifier" a pacifier dipped in sugar water , which has been shown to reduce newborn distress.

Sometimes acetaminophen is given to help with pain. Babies may also feel better when swaddled. In newborns, circumcision can be performed in several ways. Your doctor will determine which method is appropriate. A special instrument called a probe is used to separate the foreskin from the head of the penis they are usually joined by a thin membrane.

Next a bell-shaped device is fitted over the head of the penis and under the foreskin an incision may be made in the foreskin to allow this. The foreskin is then pulled up and over the bell and a clamp is tightened around it to reduce blood flow to the area. A scalpel is used to cut and remove the foreskin. Again, the foreskin is separated from the head of the penis with a probe. The foreskin is then pulled out in front of the head and inserted through a metal clamp with a slot in it.

The clamp is held in place while the foreskin is cut with a scalpel and remains for a few minutes after this to make sure that bleeding has been controlled.

This method is similar to the Gomco clamp technique. After separation with a probe, the plastic bell is placed under the foreskin and over the head of the penis.

A piece of suture is tied directly around the foreskin, which cuts off the blood supply to the foreskin. A scalpel may then be used to cut off the extra foreskin, but the plastic ring is left on. About 6 to 12 days later it falls off on its own.

After a circumcision, doctors will apply petroleum ointment over the wound and wrap the baby's penis in gauze to keep the wound from sticking to his diaper unless the doctors have used the Plastibell method, which requires no dressing. Your baby will usually be brought to you shortly after the procedure. There is very little bleeding after circumcision, no matter which technique is used.

Though you may see a little bit of blood oozing from the edge of the incision or on the diaper when you first take the dressing off, this will generally stop on its own. Your baby's penis may be sore for a few days after the procedure, so be gentle when bathing him. Never use astringent and special bath products. If poop gets on the penis, soapy water can be used to gently wipe it away. If there is a dressing on the incision, apply a new one with petroleum jelly whenever you change a diaper for the first day or two.

Even after the dressing is no longer needed, you should put a dab of petroleum jelly on the penis or on the front of the diaper for 3 to 5 days. This can help avoid discomfort from rubbing and sticking to the diaper. It usually takes between 7 to 10 days for a circumcised penis to heal from the procedure. Until it does, the tip might be raw or yellowish. Call your doctor right away if you notice any of the following:. In the first year of life, a circumcised infant is less likely to get a urinary tract infection.

It may be easier to keep a circumcised penis clean and uninfected, though boys who don't have circumcisions can be taught to properly clean beneath the foreskin once it becomes retractable usually by puberty. Later in life, studies show that circumcised men may also be at lower risk for developing cancer of the penis although the disease is rare. Circumcision may lower the risk of contracting HIV and other sexually transmitted diseases STDs from an infected female partner.

A circumcision is considered a safe procedure with minimal, if any, risks. When your child is having any kind of procedure or surgery, it's understandable to be a little uneasy. But it helps to know that circumcisions are common procedures and complications are rare. A child who has a circumcision typically heals without any difficulty or health problems. If you have any questions about circumcision, talk with your doctor. Reviewed by: Larissa Hirsch, MD.

Larger text size Large text size Regular text size.

McGowan AJ. Pollock has developed a combination block of both short and long acting anesthetic. Kalichman, Seth C ed. Lukong CS. Namespaces Article Talk. McGraw-Hill Companies, Incorporated. A circumcision performed in Central Asia, c.

Male circumcision technique

Male circumcision technique

Male circumcision technique. Navigation menu

.

Dorsal Slit-Sleeve Technique for Male Circumcision

Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics AAP recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks.

This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision.

These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.

Circumcision is the surgical removal of the prepuce foreskin either in whole or in part. Religion, cultural, medical, and recently public health reasons[ 1 , 2 ] are known to be the major indications of the procedure. Usually, it is done in neonatal period but can be performed at any age. To maximize its health benefits,[ 1 , 2 ] to reduce procedural risks and cost,[ 2 , 3 , 4 , 5 , 6 ] however, it is advocated to be offered in neonatal period.

Surgical approaches to circumcision are extremely varied. Circumcision is arguably the oldest surgical procedure in history. Currently, the public health benefits of male circumcision are topic of interest particularly as regards human immunodeficiency virus HIV prevention. Others are prematurity, bleeding problems, myelomeningocele, and anorectal anomaly.

Developmentally, during the third month of intrauterine life 65 mm fetus , a fold of skin develops at the base of the glans penis. This fold of skin grows distally from the glans penis and eventually becomes the prepuce.

This ventral fusion of the prepuce is marked by the frenulum. Preputial formation is usually complete by the fifth month of intrauterine life mm fetus. The inner surface of the prepuce and epithelium of the glans, are both stratified squamous epithelium in type, and both fuses together.

Later, presumably under the influence of androgens, the squamous cells begin to keratinize and arrange themselves in whorls. The whorled cells then disintegrate so that clefts appear between the prepuce and the glans. These clefts eventually propagate and separate the inner preputial epithelium and the epithelium of the glans from each other. This process of separation is usually incomplete at birth and continues through childhood and sometimes to adult life.

The goal of the procedure is to expose the glans sufficient to prevent phimosis or paraphimosis. Circumcision methods can be classified into one of three types or combinations thereof: dorsal slit, shield and clamp, and excision.

Shield and clamp adopts the use of device to effect circumcision obviating the use of knife in majority of cases. The device method is the commonly used method of circumcision in recent practice. The procedure is done under local anesthesia. There are many ways of achieving this: penile ring block, penile dorsal nerve block, and local anesthetic spray jet injector have all been described.

Penile dorsal nerve block is a safe and appropriate anesthesia technique for circumcision procedure. Care is taken to avoid the midline where dorsal vessels that may be cause of hematoma and poor nerve block passes. The prototype method in shield and clamp is the Mogen clamp [ Figure 1 ]. In this method, the prepuce is pulled out distal to the glans and a metal shield is slid over the prepuce immediately distal to the glans.

A scalpel is used to remove the redundant prepuce distal to the shield. The glans is protected by the shield and the frenulum is not involved in the excision. The glans and the frenulum are shielded from the knife and thus are off the harm's way. Injury to the glans and urethrocutaneous fistula is uncommon; bleeding is, however, a major concern in this method. A plastic bell [ Figure 2 ] with a groove on its back is slipped between the glans and the prepuce, an initial dorsal slit [ Figure 3 ] is usually needed to allow the bell to be placed.

The prepuce is pulled slightly forward and suture material is looped around in the groove and tied tightly. Glans necrosis and failure of the prepuce to fall-off are the two main complications of this technique. Inappropriate bell size and not tight enough suture over the prepuce are the main cause of these complications. A metal bell [ Figure 4 ] is placed over the glans after the prepuce is fully retracted.

The prepuce is then replaced over it this is facilitated by dorsal slit. A metal plate, with a machined under surface in which the rim of the bell sits, is placed over the bell. A tensioning bar is hooked under a T-shaped piece on the top of the bell and screwed down tight to the metal plate; this traps the foreskin in position.

A scalpel is run around the upper surface of the plate to remove the prepuce after adequate strangulation. Its main merit like other shield method is that the glans and the frenulum are protected. The prepuce is freed from and retracted over the glans.

Grooved sleeve is passed over the glans to sit just behind the corona. The prepuce is then replaced over this sleeve. A hinged plastic clamping ring is fitted over the sleeve [ Figure 5 ], the position of the prepuce is adjusted and the nut tightened to hold the prepuce in place.

An elastic cord is then wound tightly around the phallus, compressing the prepuce into the groove of the sleeve below it. This constricts the prepuce distally. The glans and frenulum are protected so that the frenulum remains intact. Too tight a sleeve can result in glans necrosis and too loose, one can give poor cosmetic outcome. Its merits and drawbacks are similar to that of plastibell. This works in the same way as the Tara Klamp. By trapping the prepuce between an outer ring and an inner tube, the device cuts off the blood supply to the prepuce.

The Tara Klamp is a one piece design with the locking arms at the top. SmartKlamp [ Figure 7 ] consists of separate inner tube and outer locking part with the locking arms at the side. Once the clamp is in place the excess foreskin is removed using the inside of the baseplate as a guide. The glans and frenulum are thus protected.

This is a new Chinese invention consisting of two concentric rings fitting into each other sandwiching the prepuce in between. It is said to be an effective disposable device used for mass circumcision program in HIV prevention.

The procedure is easy to learn requiring no special skill. This device is unique because of its use in adult male circumcision without the need for anesthesia. It consists of a placement ring, an inner ring, and an elastic ring. The placement ring is a carrier for the elastic ring to facilitate the application of latter during the procedure.

The inner ring has a groove on it for the lodgment of the elastic ring. When the device is applied, the prepuce is sandwiched between the inner ring and the elastic ring.

The PrePex [ Figure 9 ] device is disassembled at about a week after placement and the withered prepuce is bloodlessly severed from the penis. It is said to be safe and effective in mass rollout of adult male circumcision for the prevention of HIV infection.

In this technique, the prepuce is freed from the glans and pulled out in front of the glans. A pair of stout locking forceps is clamped across it parallel to the corona and immediately in front of the glans. The scalpel is used to remove prepuce flush to the forceps.

This method does not cut the frenulum but it can be removed before or after the circumcision if desired. Dorsal slit [ Figure 3 ] is common to many techniques and occasionally is used alone, especially in the presence of acute inflammation.

Dorsal slit prevents both phimosis and paraphimosis. Usually it is cosmetically unacceptable to carry out dorsal slit alone without excising the prepuce. Sleeve Resection: The prepuce is retracted over the glans penis [ Figure 11 ] and a circumferential incision is made around the shaft as far back as the scar line is to be placed, usually distal to the corona.

The prepuce is returned to cover the glans and another circumferential incision is made around the shaft at the same position as the first one. A longitudinal cut is made between the two circumferential ones and the strip of skin removed. The free raw edges are then sutured. The frenulum can be included in the main cutting or can be cut separately if desired. The glans and frenulum are not protected as such and care is taken not to injure them. There are several modifications of the sleeve resection.

Bloodless circumcision with the use of bipolar diathermy is described. Other described the use of an artery forceps to crush the prepuce before excision[ 11 , 20 ] [ Figure 12 ]. Laser circumcision: For its many beneficial physical properties as regards precision and sealing of cut surfaces, laser circumcision is possible.

There have been some reports of its use in hemophilia patients in Israel. Reports of this in literature are, however, rare. Excessive bleeding as complication of circumcision in reported cases ranges from 0. Transfusion for this complication is, however, unusual. In this, an excess of skin is removed from the penile shaft while not enough of the inner preputial layer has been removed.

Male circumcision technique

Male circumcision technique

Male circumcision technique