General Information

Methods of circumcision used by doctors

• The Gomco ‘Little Trimmer’ Clamp - This is the safest technique and used by Dr Demediuk.
• The Plastibell - with this technique the baby must go home with a small plastic device tied on to his penis that allows the foreskin to desiccate (dry out and fall off) over subsequent days or weeks. This is also a more lengthy procedure to perform.
• The Mogen Clamp – This technique is slightly quicker to perform but has a small risk of damage to the tip of the penis.

Pro-circumcision Websites
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1467-842X.2006.tb00079.x
http://www.medicirc.org/

Anti-circumcision Websites
http://www.bellybelly.com.au/articles/baby/circumcision-to-circumcise-or-not-circumcise

Risks and Benefits

Risks

• Significant post-operative bleeding requiring medical attention of any kind (very rare)
• Infection requiring topical antibiotic cream (occasionally), oral antibiotics (never in this practice)
• Buried or trapped penis i.e. penis gets partially buried in the abdomen (extremely rare) and requires medical intervention (never in this practice)
• Insufficient foreskin removed required medical intervention (extremely rare)
• Meatal stenosis- narrowing of the urethra requiring medical intervention (never in this practice)
• Trauma to the head of the penis (very rare)
• Phimosis or narrowing of the shaft skin opening over the head of the penis requiring medical intervention (never in this practice)
• More serious complications including death (never in this practice)
• Risks of Local Anaesthetic including bruising (common), pain because ineffective (occasional), respiratory or cardiac arrest, fitting (never in this practice)
• Acute urinary retention (never in this practice)

Benefits

• It reduces the risk of urinary tract infectionIt reduces the risk of penile infection also called balanoposthitis
• It eliminates the need to do it later in life when up to 6% of boys will require a circumcision because of various problems. (When it is done later in life, it is a more costly, difficult, and riskier procedure requiring a general anesthetic, and it is more painful)
• It reduces the risk of getting some sexually transmitted diseases including Human Papilloma Virus (HPV) and AIDS (HIV) It reduces the risk of penile cancer and cervical cancer in partners

Post Operative Instructions

Excessive bleeding or swelling following a circumcision is not normal. Should any of these, or any other unexpected complications or concerns arise, you should contact Dr Demediuk or your local doctor.

Use of Jelonet
At every nappy change, place a new 1cm piece of ‘Jelonet’ on the tip of the penis to prevent the nappy sticking to the tip of the penis. Don’t worry if it falls off between nappy changes. (use clean scissors sterilized in boiling water for 3 minutes to cut of the piece, use the piece placed by the doctor as a guide to the size, remember to peel away the paper on both sides before applying to the penis).

Soaking off the Cotton Wool
For the first 3 days following the circumcision, do not bath your son. After the 3 days, bath your baby & remove the brown coloured of cotton wool that has been wrapped around his penis by the doctor. ‘Tinc benz’ has been applied to the cotton wool, which as well as giving it the brown colour sometimes makes it difficult to remove. If this is the case, a longer soak in the bath will help. There will be a red “band” of raw tissue below the knob of the penis. This is normal and will take about a week to heal.

Use of Antibiotic Ointment
At your initial consultation, the doctor will give you a prescription for an antibiotic ointment (Bactroban). Do not fill the prescription at this time. However, if after soaking off the dressing you notice any signs of infection such redness, unusual yellow discharge, smell, excessive swelling, local warmth, or a fever then fill the script and start using the ointment three times a day.

Pain Relief
If necessary paracetamol drops can be used according to the directions for age and weight on the bottle.

Other Issues

Healing
Healing is usually rapid and occurs in several stages like any other cut. There are many factors that influence healing; but most importantly, every child heals differently usually 4-7 days for younger babies and 1-2 weeks for older babies. The area just under the head of the penis (especially the underside) may become swollen and look “like a blister”. This type of swelling is normal and will gradually subside within a week or two.

In the first few days after soaking of the cotton wool dressing, there may be yellowish, patchy areas which are a type of scab and are associated with normal healing and can last for up to 2 weeks. (This does not necessarily mean an infection has occurred) It is healing tissue. The head of the penis may appear red and glossy sometimes purple. This is because it is mucous membrane (like the skin inside your cheek). Once exposed, the mucous membrane will toughen (or keratinize), and, in time, take on a normal appearance. It takes about a month for the penis to take on a normal, healed appearance.

Extremely rarely, a poor aesthetic result may if too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. The latter is sometimes caused by the presence of a hydrocele or penile erections. In nearly all these cases, the penis will heal properly, and, in time, take on a normal appearance. If you are concerned in anyway about the appearance of your son’s penis, please to consult with Dr. Demediuk.

Heavy bleeding
Please check your baby’s nappy for any bleeding regularly for the first 24 hours after circumcision. If the baby is sleeping, you can just look at the front of the nappy from the outside. If it is not discolored, he is likely not bleeding abnormally. When you open the nappy, it is normal for the covering cotton wool to be a little red from bleeding.

You treat bleeding from the penis the same as you would for the tip of a finger:

1. Apply pressure to the penis for 2-3 minutes; no less. Do this by grasping the penis between your thumb and two fingers (over a tissue or gauze square).
2. Without removing the tissue or gauze square, inspect the area for continued bleeding and repeat step one if necessary.
3. Leave the tissue or gauze square in place and close the nappy as removing it may lead to renewed bleeding.

It is reasonable for you to try the pressure technique twice, for 2-3 minutes at a time, before calling Dr.Demediuk as most bleeding will stop with this. If the penis is dripping any blood, and you cannot stop the bleeding with the pressure technique, call Dr. Demediuk immediately on his mobile 0418 550 827. If there is no response call an ambulance on 000.

Concealed Penis
When the length of the penile shaft is no greater than its diameter or when there is a significant amount of pubic fat, the penis will tend to retract inward. This is normal. This characteristic is only a concern for the first month or two since the healing circumcision can adhere to the surrounding skin resulting in a “concealed penis”.

If your son fits this profile, you can reduce the chance of concealed penis by applying a very thin layer of Vaseline to the entire glans, once a day, until the glans takes on a healed appearance (about 1-2 months). To expose a glans that has retracted inward, place gentle downward pressure on either side of the base of the penis. Consult Dr. Demediuk if the penis cannot be fully exposed, or if any connecting skin bridges form between the shaft skin and the head of the penis.

Urinary Retention
If the baby does not pass urine within 4-5 hours notify Dr Demediuk.