Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1(Dec09)
Basic facts about counselling 3-5
Confidentiality 3-5
Counselling skills 3-6
Informed consent for surgery 3-10
General 3-10
Adolescent boys: consent and confidentiality 3-11
Documenting informed consent for surgery 3-12
Infant circumcision 3-12
Integration of traditional circumcision events with clinical circumcision 3-12
Appendix 3.1: Additional script for counselling reproductive health 3-14
Appendix 3.2: Sample information sheet for adult and adolescent clients 3-19
Appendix 3.3: Sample certificate of consent for adults and adolescents 3-23
4. Facilities and supplies, screening patients and preparations for surgery
Summary 4-1
Equipment and supplies 4-1
Maintenance and review of equipment 4-3
Screening adult clients 4-4
History 4-4
Physical examination 4-4
HIV testing and informed consent for surgery 4-6
Preoperative washing by the patient 4-7
Scrubbing and putting on protective clothing 4-7
Whether to use a gown 4-10
Face masks and protective eyewear 4-10
Appendix 4.1: Sample client record form for adults and adolescents 4-11
Appendix 4.2: Sample disposable consumables for one adult male circumcision 4-15
Appendix 4.3: Detailed anatomy of the penis 4-17
Appendix 4.4: Selected anatomical abnormalities of the penis 4-21
5. Surgical procedures for adults and adolescents
Summary 5-1
Surgical skills required for safe circumcision 5-1
Anatomy of the penis and choice of surgical technique 5-1
Tissue handling 5-1
Haemostasis 5-2
Diathermy 5-4
Suture material 5-5
Suturing 5-5
Tying knots 5-9
Skin preparation and draping 5-10
Skin preparation with povidone iodine 5-10
Draping 5-10
Anaesthesia 5-11
Penile nerve supply 5-11
Maximum dose of local anaesthetic 5-12
Safe injection of local anaesthetic 5-13
Additional analgesia 5-13
Ring block technique 5-13
Retraction of the foreskin and dealing with adhesions 5-14
Marking the line of the circumcision 5-15
Surgical methods 5-17
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