Sutureless Circumcission – Information for the patients and parents

When the foreskin won’t retract

Phimosis, or preputial stenosis, is a term that usually means any condition where the foreskin of the penis cannot be retracted.

·  Most infants are born with a foreskin that cannot be retracted and the prepuce may be tight until after puberty.

·  A fully retractable foreskin occurs in 50% of ten year olds, 90% of 16 year olds and 98 to 99% of 18 year olds.

Causes of Phimosis
Phimosis can be caused by failure of foreskin to loosen during growth, infections such as balinitis, deformities caused by trauma and diseases of the genitals.

Symptoms of Phimosis
Phimosis is usually painless condition. Infection may result from an inability to carry out effective cleaning of the area in which case swelling, redness and discharge may all be present making the area tender and painful.

A very tight foreskin can cause problems during intercourse, urination.

Paraphimosis
An inability to pull back the foreskin into position over the head of the penis can cause pain, swelling of the head of the penis and the foreskin. It may cause restricted blood flow, causing the head of the penis to become dark purple in color. If this should occur emergency treatment is required.

Inflammation Affecting Head of the Penis and Foreskin

Balanitis is an inflammation that affects the head of the penis and/or the foreskin.

Most common in men over 40 years old, Balanitis is a condition affecting about 11% of adult men and 3% of children. Balanitis is characterized by shiny red to orange plaque (area). It can also present as a yellow hue with red pinpoint spotting.

Signs Symptoms of Balanitis
Occurring only in uncircumcised men, balanitis causes the following symptoms:

·  Tenderness

·  Discharge from the penis

·  Impotence

·  Swelling

·  Difficulty with passing urine

·  Inability to retract the foreskin

Causes of Balanitis
The causes of balanitis are not known for sure but include:

·  Friction

·  Poor hygiene

·  Response to infection.

Various viruses and organisms can cause balanitis. These include HPV (human papilloma virus)

·  Chemical irritants (ie condoms) an allergic reaction

·  In overweight and obese men

·  Penis cancer

·  Diabetes

Complications of Balanitis
The most common serious complication of balanitis is phimosis, an inability to retract the foreskin from the glans penis.

The Circumcision Operation
In Ireland circumcision can be performed after 1 year of childs birth,this is recommendations from the college of anesthesia .

A straight forward circumcision will take about 5 to 10 minutes. When a circumcision is performed for medical conditions the procedure will take longer. we use a special medical glue to join the edges of the cut foreskin.In adults 3-4 desolvable stitches are are used in addition.

The type of anesthesia used for circumcision will depend on the procedure being performed and on the patients age. Babies will often only have a numbing medicine along with a very short GA .

How to Care for Your Wound After a circumcision procedure

it is important to take good care

of the surgical site to minimise

the risk of infection and

promote healing.

• Keep the area clean and dry

72 hours after the operation, gently wash the

area with warm water each day to prevent

infection. After washing, pat the area dry with a

clean towel.

• Wear loose-fi tting clothing

Tight clothing or underwear can rub against the

surgical site causing irritation and discomfort.

Loose clothing allows the area to breathe and

promotes healing.

• Avoid strenuous activity

You should avoid strenuous physical activity,

such as sports or heavy lifting for at least 3

week after the procedure.

• Take pain medication as needed:

Over-the-counter pain medication,

paracetamol/Ibuprofen can help to relieve any

discomfort or pain.

• Monitor for signs of infection

Watch for signs of infection, such as redness,

swelling, fever or pus drainage from the surgical

site. If you notice any of these symptoms,

contact your healthcare provider.

It is important to follow your healthcare

provider’s instructions for post-operative

care and attend any follow-up appointments

as scheduled.

Side effects of circumcision requiring

medical attention include:

BLEEDING: Blood loss in a small infant is potentially

dangerous, slight bleeding including staining of

the cloths/nappies is ok. If the child or adult is

continuously bleeding, apply pressure over the wound

site as you hold a stick in your hand and contact the

hospital where he had the circumcision.

· If a child fails to pass urine after 6 to 8 hours after the

operation contact the hospital or Mr Jaffry’s offi ce.

There may be a scab blocking the meatus. This is

usual in some cases as the raw area over the meatus

will form a scab which causes inability to pass urine.

· If swelling and redness around the top of the penis

does not go or becomes worse after 3 to 5 days,

contact Mr Jaffry’s offi ce (091 720065). An Important

factor here to remember is progression of symptoms,

if the symptoms are not progressing you can wait.

· A yellow discharge (not staining of clothes) around the

penis tip may indicate an infection (if it persists after

3-5 days). It is very unusual to get a post operative

infection and if it does, this usually settles with

frequent washing and keeping it clean and dry.

· Antibiotics are not usually necessary but if the GP or

your physician feels it’s necessary then you have to

commence same.

· Calpol (Paracetamol) and/or Neurofen (Ibuprofen) is

usually effective alternately until any swelling and

pain subsides.

· You may remove the dressing after 72 hours of

the operation. This will include removal of a ribbon

gauze wrapped around the penile would , this

has to be unrolled. A net dressing called mepitel

dressing will be found underneath it and has to be

peeled off. Usually its easy to peel it off the wound.

· You may start washing the wound after the

dressing is removed ie: 72 hours after the

operation, with clean water and cotton wool.

· Do not apply any type of creams/gels or soaps after

washing, until you are advised by Mr Jaffry.

· The wound can separate and that usually settles

itself, however a regular visit with Mr Jaffry may be

necessary in some cases to make sure the wound

is healing well. This is mainly due early morning/

nocturnal tumescence in both adults and children.

· Post operative pain in adults may take number of

weeks (6-8) to settle.

· For adult patients refrain from sexual intercourse

until your fi nal review at the rooms.

· Please note that in patients who have a pubic fat

pad, they may have additional cosmetic problems

initially, which would have been discussed at initial

consultation, just to reiterate, a circumcision

procedure does not effect the overall size of the

penis however the appearance may look small

and there could be delayed healing/infection and

webbing of the skin post operatively.

· In patients with BXO and other chronic

infl ammatory conditions the recovery may be

extended and can cause prolonged side effects

and complications like infection, bleeding, scab

formation, meatal closure, altered/hyper sensation

around penile skin, discolouration of penis and skin

fi brosis at closure site. This is the usual course in

some patients, which requires close monitoring

and regular follow up with Mr Jaffry to achieve an

optimum outcome

Mr Syed Jaffrey
Consultant Urological Surgeon
University Hospital Galway
Bons secours
Galway Clinic