Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Treatment for phimosis If seen at a peripheral health facility, adult patients with phimosis should be referred to a higher level of care for proper assessment and treatment; this will usually involve circumcision. Paraphimosis Paraphimosis occurs when the retracted foreskin cannot be put back in place because of swelling (Fig 2.3). This usually occurs when the penis is erect and during sexual intercourse. The retracted foreskin swells and tightens around the penis. This tightening in turn causes more swelling. Men with paraphimosis should be referred to the district hospital for emergency treatment. If left untreated the condition can result in serious complications, such as skin loss and infection; in extreme cases, it could result in loss of the penis. Fig. 2.3 Paraphimosis. A tight band of foreskin constricts the shaft of the penis; the foreskin is swollen with oedema beyond the band. Reproduced with permission from www.netterimages.com (image no. 1468). Treatment of paraphimosis Treatment depends on how long the paraphimosis has been present. For acute paraphimosis, wrap the swollen area in gauze and apply increasing pressure on the gauze to squeeze the tissue fluid (oedema) out of the penis. This may take 10–15 minutes. Once the fluid has been squeezed out, it is usually possible to replace the foreskin over the glans. Circumcision can then be done as a planned procedure a few days later. If this procedure fails, or in cases of chronic paraphimosis, the man should be sent to the nearest surgical referral centre. Linking male circumcision and other male SRH services Chapter 2-10
Male circumcision under local anaesthesia Version 3.1 (Dec09) Urinary tract infections Urinary tract infections are infrequent in adult men, but more frequent in children and older men. Usually there is an underlying cause, for example, kidney or bladder stones. Symptoms include: • frequent urge to urinate; • pain and a burning feeling in the area of the bladder or urethra during urination (dysuria); • feeling tired, shaky, and weak (malaise); • feeling pain in the bladder or urethra even when not urinating; • passing only a small amount of urine, despite an intense urge to urinate; • milky or cloudy urine; sometimes urine may be reddish, indicating that blood is present; • fever (suggesting that the infection has reached the kidneys); • pain in the back or side, below the ribs; • nausea; • vomiting. Urinary tract infections in men should be distinguished from urethral discharge caused by an STI. A patient with a urinary tract infection should be told to drink plenty of water, starting immediately. He should also be given an appropriate. Men and boys with recurrent urinary tract infection, or who do not respond to treatment at the first level of care, should be referred for further investigations. Infertility Between 60 and 80 million couples around the world are infertile, and most of them live in developing countries. Infertility is defined as failure to conceive after at least 12 months of unprotected vaginal intercourse. A large proportion of cases of infertility in developing countries are attributable to STIs, which can damage the fallopian tubes in women and obstruct the sperm ducts in men, particularly when left untreated. Reproductive tract infections in men can affect the prostate (prostatitis), the epididymis (epididymitis), and the testes (orchitis). In many societies, childlessness is highly stigmatizing, and the couple’s emotional response to their infertility is often exacerbated by family, peer and media pressure. Frequently the female partner is considered responsible for the failure to conceive, commonly resulting in marital tension, divorce, polygamy or ostracism. However, a WHO investigation of 5800 infertile couples found that reduced male reproductive capacity was a contributory factor in at least 50% of infertile couples. 7 In order to provide more efficient, systematic and cost-effective care for infertile couples, and to improve the accuracy of diagnoses, health care providers managing an infertile couple should ensure that all essential information is collected. The WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple provides clear guidelines and a logical sequence of steps for clinicians to follow in evaluating both partners in an infertile couple. 8 Linking male circumcision and other male SRH services Chapter 2-11
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Manual for Male Circumcision under Local Anaesthesia

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