Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) (Photo courtesy of R Bailey, Kisumu Circumcision Project) Fig. 5.13 Injection of local anaesthetic for the ring block technique Fig. 5.14 The ring of local anaesthetic after injections have been made during the ring block technique RETRACTION OF THE FORESKIN AND DEALING WITH ADHESIONS This step is common to all the methods of circumcision described below. After effective local anaesthesia has been achieved, the foreskin should be fully retracted. If the opening of the foreskin is tight, it may be necessary to dilate it with a pair of artery forceps (Fig. 5.15), but this is not usually necessary in adults and adolescents. Care must be taken to stretch just the aperture of the foreskin and not to push the forceps in too far, because there is a risk of dilating the urethra and causing injury to the urethra and glans. Surgical procedures for adults and adolescents Chapter 5-14
Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 5.15 Dilation of the aperture of the foreskin. Do not push the forceps in too far, in order to avoid injury to the urethra Once the foreskin has been retracted, separate any adhesions by gentle traction or using a blunt probe, such as a pair of closed artery forceps (Fig. 5.16). If adhesions are particularly dense, the surgeon may decide to abandon the procedure and refer the patient to a more experienced surgeon. Gently divide adhesion by traction or with Fig. 5.16 Retracting the foreskin to fully expose the glans and separate any adhesions MARKING THE LINE OF THE CIRCUMCISION This step is common to all the methods of circumcision described below. With the foreskin returned to a natural “resting” position, indicate the intended line of the incision with a marker pen. The line should correspond with the corona, just under the head of the penis (Fig. 5.17). Some uncircumcised men have a very lax foreskin, which is partially retracted in the resting position. In such cases it is better to apply artery forceps at the 3 and 9 o’clock positions, to apply a little tension to the foreskin before marking the circumcision line (illustrated in Fig 5.28 below). However, it is important not to pull the foreskin too hard before marking the line, as this will result in too much skin being removed. If a marker pen is not available, dabs of gentian violet may be applied with a blunt probe, the tip of an artery forceps or other sterile instrument. Pinch marks made with a toothed forceps are also an alternative. Surgical procedures for adults and adolescents Chapter 5-15
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Manual for Male Circumcision under Local Anaesthesia

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