CIRCUMCISION

Encep Ivan S
Male circumcision?

“Circumcision is the surgical removal of

the foreskin, the fold of skin that covers
the head of the penis. “

“It is widely practised for religious and

traditional reasons, and may also be
performed for medical reasons to treat
problems involving the foreskin.”
When Is Circumcision Done?
Circumcision can be done as soon as possible after the baby is
born. But this process is not common in Indonesia. Usually
circumcision is done when a boy has reached primary school
age. At this time, the child is expected to have more tolerate
the pain that arises than if done during toddlers. However, this
process can be accelerated if there is a certain risk or disease at
a younger age that requires treatment by circumcision method.

Circumcision has absolutely no effect on male fertility.

Benefit?
1. It is easier to keep the penis clean.
2. There is a reduced risk of urinary tract infections in childhood.
3. Circumcision prevents inflammation of the glans (balanitis) and the
foreskin (posthitis)
4. Circumcision prevents the potential development of scar tissue on
the foreskin, which may lead to phimosis (inability to retract the
foreskin) and paraphimosis (swelling of the retracted foreskin
resulting in inability to return the foreskin to its normal position).
5. There is a reduced risk of some sexually transmitted infections
(STIs), especially
2, 3
ulcerative diseases, such as chancroid and
syphilis.
6. There is a reduced risk of becoming infected with human
immunodeficiency virus (HIV).
7. There is a reduced risk of penile cancer.
8. There is a reduced risk of cancer of the cervix in female sex
partners.
Indications
Phymosis and Paraphymosis

5
Contraindications
Epispadia and Hypospadia

Hemostasis abnormality (hemofilia,

trombocytopenia, aplastik anemia, Vit. K
Deficiency)
 Acute penile Infections 6
Complications occurring during surgery
 Excess bleeding during surgery.
 Bleeding from the frenular artery.
 Accidental injuryAccidental injury can include injury to the
glans (e.g. partial severing of the glans)
 Severing of the glans.
Late complications
 Decreased sensitivity of the glans;
 Oversensitivity of the glans;
 Unsightly circumcision wounds, ragged scars or other cosmetic
concerns;
 Persistent adhesions at the corona and inclusion cysts.
 Discomfort during erection from the scrotal being skin pulled up the
shaft of the penis and a tight scrotal sac.
 Torsion (misalignment) of the skin of the penile shaft.
 Meatal stenosis
Surgical procedures for
Circumcision
Circumcision Technique
In Indonesia, there are generally three most commonly used
circumcision techniques. Before circumcising or choosing a
circumcision method for a child, make sure you know the
process along with the advantages and disadvantages of each
of these methods.

1. Dorsumsition
2.Clamp
3. Electric cauter
Dorsumsisi

It is a conventional method that is done by slicing the foreskin until it is loose using scissors or surgical
separation. This process is generally performed on children and adults with local anesthetic methods.

Advantages:

Can be applied to hyperactive and autistic patients

Deficiency:

The healing process is relatively long.

Post-circumcision, patients need to use bandages and cotton as a buffer so that the penis does not
move much.
Leaving the wound of the former circumcision suture.
The process of work is relatively long, about 30-50 minutes.
The wound should not be exposed to water for several days in order to heal faster.
Clamp

Clamps are special plastic tubes of different sizes according to penis size. The foreskin is cut in a circle
with a scalpel after the clamp attached to the penis. The clamp will remain attached to the penis until
the wound dries about 3-6 days later. After the wound is dry, the clamp will be removed by the doctor.

Advantages:

Minimal bleeding, no stitches or bandages.

Wounds of circumcision are allowed to be exposed to water.
The process takes only 7-10 minutes.
The relative pain is less noticeable, so that post-circumcision patients can move as usual.
Costs are more expensive than conventional methods, but are relatively more affordable than using
lasers.

Deficiency:

Clamps are still attached to the penis until approximately 5 days after circumcision.
Implementation in hyperactive or autistic children requires extra care so that your baby does not
remove the clamp that is still attached.
Laser (electric cauter)

Penile foreskin cutting of the penis is done with a heat element of electrically grounded wire or metal.

Advantages:

Bleeding and minimal stitching.

The duration of healing is relatively faster than conventional methods.
It only takes 15-30 minutes.
No need to use hanging tools like the clamp method.
Deficiency:

The procedure should be performed by the surgeon. If not done properly, the penis is feared to close
again.
Wounds of circumcision should not be exposed to water for several days.
It could cost more because it was done by a surgeon.
If performed on a toddler, your doctor may suggest total anesthesia.
SKIN PREPARATION AND DRAPING
Anaesthesia
Circumcision can be done under general or local anaesthesia.
Local anaesthesia is preferred, because it is less risky and less
expensive.
There are two possible techniques for local penile anaesthesia: the
penile nerve block and the ring block.
The ring block technique is used for circumcision of adults and
adolescents.
The penile nerve block is used for circumcision of infants
Penile nerve supply
 The nerve supply of the penis is the twin dorsal penile nerves.
These nerves are located on the top and sides of the penis, at
the 11 o’clock and 1 o’clock position near the base of the penis.
 Maximum dose of local
anaesthetic

Lidocaine with epinephrine must not be used because there is a risk of

constriction of the blood vessels to the whole penis, which can cause
gangrene and loss of the penis.
Ring block technique
Dorsal penile nerve block
 Anaesthesia is recommended for paediatric circumcision is
with dorsal penile nerve block.
 The maximum safe dose of lidocaine in children is 3 mg/kg of
body weight. For a 3-kg baby, this corresponds to 0.9 ml of 1%
solution or 1.8 ml of 0.5% solution
 Anaesthetic solutions containing epinephrine (adrenaline)
should never be used.
RETRACTION OF THE FORESKIN AND
DEALING WITH ADHESIONS
DORSUMSISI / DORSAL SLIT
the sleeve resection method
The forceps-guided method;
Control Bleeding
Dressing

The dressing should be left in position no longer than 48

hours.
Thank You
Reference and further reading