Manual for Male Circumcision under Local Anaesthesia

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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 Page iv
Male circumcision under local anaesthesia Version 3.1(Dec09) Forceps-guided method of circumcision 5-17 Dorsal slit method of circumcision 5-23 Sleeve resection method of circumcision 5-27 Dressing 5-31 Appendix 5.1: Variations in technique for minor abnormalities of the foreskin 5-33 6. Circumcision of infants and children Summary 6-1 Screening male babies and young boys for circumcision 6-1 Consent 6-2 Preparation 6-2 Anaesthesia 6-2 Safe injection of local anaesthetic 6-3 EMLA cream 6-4 Glucose by mouth 6-5 Vitamin K 6-5 Skin preparation and draping 6-5 Retraction of the foreskin and division of adhesions 6-6 Paediatric surgical methods 6-7 Suture material 6-8 Dorsal slit method for children 6-9 The Plastibell method 6-13 The Mogen clamp method 6-17 The Gomco clamp method 6-20 Appendix 6.1: Information for parents considering circumcision for their child 6-25 Appendix 6.2: Sample consent document for a minor 6-27 7. Postoperative care and management of complications Summary 7-1 Postoperative care 7-1 Postoperative monitoring 7-1 Instructions for the client 7-2 Transfer of client records 7-3 Follow-up visits 7-3 Routine follow-up 7-3 Emergency follow-up 7-4 Recognition and management of complications 7-4 Organizing referrals 7-5 Complications occurring during surgery 7-5 Complications occurring within the first 48 hours after surgery 7-7 Complications that occur within the first two weeks after surgery 7-8 Late complications 7-8 Appendix 7.1: Sample postoperative instructions for men who have been circumcised 7-10 8. Prevention of infection Summary 8-1 Basic concepts 8-2 Standard precautions 8-3 Hand hygiene 8-3 Washing hands with soap and water 8-5 Alcohol-based handrub 8-6 Page v
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Manual for Male Circumcision under Local Anaesthesia

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