Circumcision

Introduction

Circumcision is a surgical procedure to remove the foreskin and mucosal tissue that covers the glans of the penis, with the wound being closed with absorbable sutures. After the operation, the glans of the penis will no longer be covered by the foreskin. Additional surgery may be required if other congenital structural abnormalities are discovered during the procedure, but this is very rare. In such cases, the doctor must immediately inform the parents of the specific details of any additional surgery performed.

Indications

• Phimosis (tight foreskin opening preventing the glans from being exposed)
• Phimotic incarceration (the foreskin opening is tightly constricted around the glans penis at the coronal sulcus and cannot be timely repositioned)
• Recurrent balanitis
• and abnormalities of the urinary system, which can lead to urinary tract infections.

Risks and complications

1. Surgical period
2. Anaesthetic complications
3. Damage to organs such as the glans penis and urethra, or excessive foreskin removal
4. If a congenital abnormality of the urethral opening is discovered after retracting the foreskin, it may be decided to also carry out urethral opening repair surgery, or it may be decided that a circumcision is not suitable.

Early post-operative period

1. Wound infection
2. Heavy bleeding from the wound
3. Urinary tract infection
4. Crusting and exudation
5. Acute urinary retention (difficulty passing urine due to wound pain)
6. The wound has reopened.
7. Late post-operative (rare)
8. Urethral stricture (narrowing of the urethral opening due to infection and subsequent scarring)
9. Large scar on the penis
10. Skin tags and skin bridges
11. Circumcision wound scar bleeding
12. Peyronie's disease
13. Penis entrapment
14. Erection tightness, pain
15. Psychological and sexual psychological disorders

Some complications may require follow-up treatment or further surgery.

Pre-operative preparation

1. Fast as per the anaesthetist's instructions
2. Patients are generally required to fast from food and drink for 6 hours before surgery.
3. In special circumstances, an anaesthetist may cancel an operation.
4. Local penile anaesthesia can reduce post-circumcision pain.

Surgical procedure

1. The surgery must be performed under local or general anaesthesia.
2. To have an appropriate length of foreskin removed
3. To close the wound with absorbable sutures.
4. The dressing is wrapped loosely around the penis.
5. If appropriate, the patient can be discharged home on the date of surgery.

Post-operative care

1. After urination, the post-operative dressing should be removed.
2. A paper cup can be used to protect a wound.
3. Wash the wound with clean water after urinating and pat it dry.
4. If there is slight bleeding, press directly on the bleeding area.
5. Can shower
6. The wound and surrounding tissue will swell for at least a week, which is normal.

Notes
This leaflet provides only basic information about the surgery, and not all possible risks or complications can be listed. The risk level also varies for different types of patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/paedsurg_circumcision_0193_chi.pdf