Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section v: operations on the scrotum, penis, and urethra
3-39
3-39. CIRCUMCISION
a. General.
(1) This procedure is the excision of the foreskin (prepuce) of the glans penis. It is done prophylactically in infancy and is commonly performed in the newborn period. For Jewish patients, this may be a religious rite performed by a rabbi. Provision should be made in a hospital to observe the religious needs and preferences of parents in this regard.
(2) Circumcision is done for the relief of phimosis, a condition in which the orifice of the prepuce is too small to permit easy retraction behind the glans. Circumcision may be done to relieve paraphimosis, a condition in which the prepuce cannot be reduced from a retracted position.
b. Patient Preparation. Newborn infants are generally positioned on specially constructed boards that facilitate restraint by immobilizing the limbs and exposing the genitalia. No anesthesia is used for newborn infants. Older patients may be given a general or local anesthetic.
c. Operative Procedure.
(1) If the foreskin is adherent, a probe or hemostat may be used to break up adhesions. The foreskin is grasped with an Allis forceps and stretched taut over the glans. A superficial, circumferential incision is made in the skin at the level of the coronal sulcus at the base of the glans. A straight hemostat may be placed at the medial dorsal aspect and the foreskin cut from the meatus to the sulcus with a straight scissors or scalpel. The foreskin is then completely excised at the level of the sulcus. Bleeding vessels are clamped with mosquito hemostats and tied with fine number 2-0 plain gut ligatures.
(2) The raw edges of the skin incision are approximated along the corona with fine number 4-0 chromic sutures on Atraumatic needles. The wound may be dressed with petrolatum or hemostatic gauze, if desired.
(3) The plastibell method for infants is done in a somewhat different way. A dorsal slit is made, adhesions freed, and the bell placed over the glans inside the foreskin. A suture is tied lightly around the bell, compressing the foreskin into the groove. The free skin is trimmed and the bell handle is broken off.
