Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
about what has happened and the plans to deal with the complication.
Anxiety and fear of the unknown add to the distress caused by
complications. These can be greatly reduced if the client is given clear
explanations about what is happening.
For example, a complaint of increasing penile pain and fever 4–5 days
after surgery is indicative of wound infection. If there are signs of
infection on examination, the client should be given antibiotics and the
situation reviewed after 24–48 hours, depending on the severity of the
complaint. In these circumstances, the client and his family should be
told there is an infection, that antibiotics are needed, and when the
situation will be reviewed.
Organizing referrals
A circumcision team working in a clinic setting should have a formal
arrangement with the nearest referral centre, so that there are no
bureaucratic obstacles when referral is required. When strengthening
or establishing national or local circumcision services, adequate
funding for referrals should be included as part of the cost of the
circumcision service.
Many complications can be managed in the clinic setting, but
occasionally emergency transfer may be needed. When there is a
need for emergency transfer, the following general rules apply:
• The client should be transferred by ambulance, lying flat.
• The client and his family should be given a full explanation of what
is happening and why.
• A clear note should be sent to the referral centre with the client.
• The client should be told not to eat and, depending on the length
of the journey, not to drink, as a general anaesthetic may need to
be given at the referral centre. Any accompanying family member
should also be given this information.
Complications occurring during surgery
• Excessive adhesions. If the client has phimosis, so that the
foreskin cannot be retracted prior to surgery, there is uncertainty
about what will be found once the dorsal slit has been made and
the foreskin retracted. If there are excessive adhesions, it may be
difficult to separate the foreskin from the glans. Depending on the
experience of the circumcision team, it may be better to stop the
procedure and refer the man to a hospital. In this situation, the
dorsal slit will have to be repaired, using stitches to stop bleeding.
It will not be possible to put on a dressing because the man will
need to urinate. Nevertheless, the area should be kept as clean as
possible. The wound should be covered with a gauze swab, which
the man can keep in place by wearing tight underpants.
Arrangements should be made for the man to attend the local
Postoperative care and management of complications Chapter 7-5