Manual for Male Circumcision under Local Anaesthesia

More documents

Recommendations

Info

Male circumcision under local anaesthesia Version 3.1 (Dec09) RETRACTION OF THE FORESKIN AND DIVISION OF ADHESIONS In infants and children, the foreskin is commonly fused to the glans by fine adhesions. These adhesions are normal. Before circumcision is performed, it is necessary to separate them. Before the foreskin can be retracted it may be necessary to stretch the opening with an artery forceps. Care must be taken to avoid putting the tips of the forceps into the urethral meatus, in order to avoid injury. Fig. 6.2 Stretching the foreskin opening with an artery forceps Once the opening has been dilated, slowly retract the foreskin and separate adhesions by gently running a blunt probe around the glans or using gauze to separate the glans from the foreskin, until the corona is exposed. An alternative to a blunt probe is the tip of a closed pair of mosquito artery forceps. It sometimes helps to moisten the glans with chlorhexidine or povidone iodine, or to apply some sterile gel when separating adhesions. Fig. 6.3 Retraction of the foreskin and gentle division of adhesions with a blunt probe Infant and paediatric circumcision Chapter 6 - 6
Male circumcision under local anaesthesia Version 3.1 (Dec09) PAEDIATRIC SURGICAL METHODS Four techniques for circumcision of children are described in this section: the dorsal slit method, the Plastibell method, the Mogen clamp method, and the Gomco clamp method. The dorsal slit method with closure of the wound with suture is not typically used for infant male circumcision and is more appropriate for older children, particularly in situations where the surgeon undertakes relatively few procedures so that it is not practical to stock devices. A small dorsal slit is a preliminary step when using the Gomco and Plastibell devices. Typically, in early infancy, the wound does not need to be closed with sutures, regardless of the device used. In babies, the foreskin is long in relation to the penis, and there is little chance of penile erection. This has two important consequences. First, the glans will be further exposed towards puberty, as the penis grows relative to the foreskin. Second, clamping devices that remain on the penis for a few days (e.g. the Plastibell device) are more feasible than with adults, because there is less chance of the device being pushed off by an erection. In early infancy (< 60 days of age), regardless of which technique is used, closure of the wound is typically not necessary. Beyond early infancy (>60 days) better cosmetic outcomes may be achieved if the wound is closed with simple interrupted sutures. The Plastibell provides a unique benefit over the other techniques in that it can be used outside of the early infant period without regularly requiring surgical closure. Extremely rare complications such as loss of the glans, urinary retention and bladder rupture have been reported with the use of the Plastibell device as a result of migration of the ring onto the shaft of the penis, which may happen if the wrong size is used. The Plastibell should only be considered in areas where follow up is both reliable and easily available. The Plastibell is a disposable device, whereas the Mogen and Gomco clamps are reusable. The choice between the different techniques may depend on the cost of the Plastibell, the need to sterilize the Mogen and Gomco clamps, the ages at which circumcision is performed, and the possible need for suturing skills. The advantages and disadvantages of the different methods of paediatric circumcision are summarized in Table 6.2. Infant and paediatric circumcision Chapter 6 - 7
Page 1:
Male circumcision under local anaes
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70: Male circumcision under local anaes
Page 119: Male circumcision under local anaes
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185:
Page 190:
For more information, please contac
show all

Manual for Male Circumcision under Local Anaesthesia

Create successful ePaper yourself

Delete template?

Save as template?