CIRCUMCISION METHODS

Male circumcision is one of the oldest and safest procedures.

It is defined simply as the surgical removal of a fold of skin (the `foreskin’ or `prepuce’) that covers the head (glans) of the un-erect penis.

The procedure is pain free because it is carried out under local anaesthesia. Local anesthetic cream (EMLA or LMX4) is applied before the local anaesthetic injection is injected into the base of the penis.

Any of the techniques mentioned below can be used depending upon the clinical indication of each individual patient.

Plastibell Method (Ring Method) is the most popular and common method of circumcision which is highly recommended and suitable for infants and young boys unless indicated otherwise.

The Circumplast or Plastibell is a clear plastic ring with a handle and has a deep furrow running all the way around it. It provides a “no scalpel” circumcision technique in that the foreskin is not cut off the penis during the procedure, but at the end of the procedure.

The adhesions between glans and foreskin are divided with an artery forceps.The foreskin is then cut longitudinally starting at the distal end dorsally to allow it to be retracted so that the glans is exposed. The appropriate size of either the Circumplast (available in 4 sizes) or Plastibell (available in 6 sizes) is chosen and placed on the head. The foreskin is then pulled over the ring and a ligature is tied firmly around the foreskin, crushing the skin against the groove in the Circumplast / Plastibell. The handle is broken off at the end of the procedure and finally the excess skin protruding beyond the ring is then trimmed off.

The entire procedure takes about 5 to 10 minutes, depending on the experience and skill of the operator. The compression against the underlying plastic shield causes the foreskin tissue to die off and thus the ring falls off in 3 to 14 days leaving a smooth circumferential wound that will heal over the following week.

Chemical (Silver nitrate) or electro-cautery (bipolar diathermy) is used to control minor bleeding during the procedure.

The recognised but rare potential risks of the procedure are: bleeding (rare but definite), infection, ring displacement / retention (can be easily managed by the surgeon) and residual excess skin remaining.

It is quite a common method of circumcision and only takes around half an hour to perform. It is appropriate for infants, young boys and adults, though it is more suitable for young boys and adults.

This involves incisions made with a scalpel in both the outer and mucosal surfaces of the foreskin. First the foreskin is slid back along the shaft and a freehand cut is made around the shaft as far back as the scar line is to be placed. The foreskin is then returned to cover the glans and another cut is made around the shaft at the same position along its length as the first. A longitudinal cut is made between the two circumferential cuts and the strip of skin is removed. Any bleeding during the procedure is stopped with the use of Bipolar Diathermy (electrocautery). The two edges are then pulled together and fine absorbable sutures on an atraumatic cosmetic surgery needle are applied. At the end of the procedure the wound is first covered with Gelonet (a gauze lubricated generously with petroleum jelly) and finally by a clean gauze on top.

The recognised but rare risks of the procedure are: bleeding (rare but definite), infection, and residual excess skin remaining.