Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Information for parents The parents of infants and children who have had a dorsal slit circumcision should be told that it is not necessary to use a dressing, and the baby can be looked after in the regular way, including normal washing and use of nappies. Healing is usually complete after about one week. The parents should be told to come back to the clinic if: • the child appears to be distressed or in pain; • the child has fever; • the child does not wake for feeding as per his usual pattern; • the glans or wound becomes discoloured; • there is any separation of the skin edges; • there is any unusual swelling or bleeding; • the child has any difficulties with urination; • the parents have any other worry about healing. Infant and paediatric circumcision Chapter 6 - 12
Male circumcision under local anaesthesia Version 3.1 (Dec09) The Plastibell method The Plastibell technique is widely used and has been shown to be acceptable and practical in developing country settings. This technique requires less surgical skill than the dorsal slit method to produce a neat result. It can be used in children up to age 10–12 years, and can be used with EMLA anaesthetic cream. However, as for other surgical methods, incorrect technique can result in complications. Any clinic offering Plastibell circumcision needs to have in stock the full range of bell sizes. If the bell used is too small, it may cause pressure necrosis and injury to the glans. If the bell is too large, it may slip over the glans onto the shaft of the penis and cause constriction. In extreme cases this may result in gangrene and loss of the glans and/or urinary retention and bladder rupture. fgh For these reasons, the Plastibell technique is only recommended for use in clinics that regularly perform paediatric circumcisions and follow-up can be assured; it is not recommended for occasional use. The Plastibell is manufactured by the Hollister Company and comes in six different sizes each in a sterile package. Fig. 6.9 The Plastibell device (manufactured by Hollister Inc., 2000 Hollister Drive, Libertyville, Illinois 60048, USA) Step 1. Select the correct size of Plastibell according to the girth of the glans. The most commonly used sizes are 11 or 13 mm. Step 2. After cleaning, draping anaesthesia, and marking the line of the circumcision over the corona. retract the foreskin f g h Bode C, Ikhisemojie S, Ademuyiwa A, Penile injuries from proximal migration of the plastibell circumcision ring. Journal of Pediatric Urology 2009.05.011 Mihssin N. Retention of urine: an unusual complication of the Plastibell device. BJU International. 1999; 84, 745 Jee LD. Ruptured bladder following circumcision using the Plastibell device. Br J Urol 1990;65:216-7 Infant and paediatric circumcision Chapter 6 - 13
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Manual for Male Circumcision under Local Anaesthesia

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