Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) MEDICAL HISTORY 15. Does the patient have a history of any of the following a. Haemophilia or bleeding disorders: Yes No b. Diabetes: Yes No 16. Is patient currently being treated or taking medications for any of the following a. Anaemia Yes No b. Diabetes: Yes No c. AIDS: Yes No d. Other (specify)___________ Yes No 17. Does patient have any known allergy to medications Yes No If yes, specify:___________________________________________ 18. Has patient had a surgical operation Yes No If yes, specify nature, date and any complications: ___________________________________________ 19. Does the client have any of the following complaints a. Urethral discharge: Yes No b. Genital sore (ulcer): Yes No c. Pain on erection: Yes No d. Swelling of the scrotum: Yes No e. Pain on urination: Yes No f. Difficulty in retracting foreskin: Yes No g. Concerns about erection or sexual function: Yes No h. Other (specify)________________ Yes No Facilities and supplies and preparation for surgery Chapter 4-12
Male circumcision under local anaesthesia Version 3.1 (Dec09) PHYSICAL EXAMINATION OF GENITALS 20. Any significant abnormality on general genital examination (e.g. hypospadias, epispadias) Yes No If yes, specify__________________ 21. Examination of penis: Normal Abnormal (e.g. phimosis, paraphimosis, discharge, genital warts, genital ulcer disease) specify_____________________ SUITABILITY FOR CIRCUMCISION PROCEDURE 22. Has client given informed consent for circumcision Yes No 23. Is client suitable for circumcision at the clinic Yes No 24. Is client in good general health Yes No If client is not in good general health, circumcision should be delayed until he has recovered. If client shows signs of immunodeficiency (e.g., severe unexplained weight loss, unexplained recurrent opportunistic infections, requires bed rest for at least half the day), client should be referred to a higher level of care and an HIV test should be performed to verify that client does not have HIV infection. CIRCUMCISION PROCEDURE 25. Type of anaesthesia: Local (penile nerve block with lidocaine) General Other (specify)__________________________ 26. Type of circumcision procedure: Dorsal slit method Sleeve method Forceps-guided method Other method (e.g. appliance), specify___________________________ 27. Date of operation: / / Day Month Year 28. Surgeon:_____________________ Nurse: __________________________ 29. Start time:________ End time:________ Duration:____________ minutes Facilities and supplies and preparation for surgery Chapter 4-13
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Manual for Male Circumcision under Local Anaesthesia

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