Paediatric urologist

Benefits Of Circumcision

Circumcision is a common procedure with minimum risks of complications by trained professional doctors. There are different opinions whether there is a need for a male to be circumcised.

Many medical studies and research showed that boy under 1 year is an optimal time for clinical circumcision. In our experience ideal age of circumcision is in babies under 4 weeks because a baby’s low movement facilitates the use of local anesthesia, usually sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal in this age group (ranges from £250) , and risks of complications are uncommon. Infant circumcision is safe, simple, convenient and cost-effective procedure.

The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis (tight foreskin) and paraphimosis ( foreskin stuck behind the head of penis)

When the men later becomes sexually active he has substantial protection by circumcision against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced.

Tight foreskin in adolescence or adulthood may evoke a fear of pain, sexual pain or reduced sexual pleasure. Tight foreskin may be due  Balanitis Xerotica Obliterans (BXO) which may required  circumcision. Balanitis Xerotica Obliterans (BXO) is a penile skin condition which affects the foreskin, It may also affect the rounded head of the penis (called the ‘glans penis’) and, less commonly, the urethra (the tube which carries the urine from the bladder out of the body).

In BXO there is long term (chronic) inflammation of the glans penis; referred to as ‘balanitis’.  Patches (called lesions) appear on the affected skin which have an abnormally dry appearance (referred to as ‘xerotica’) and are seen as white, thickened plaques.  Lesions start in the foreskin but then can extend to the surface of the skin on the glans penis causing the involved areas of skin to fuse together.  As a result, the foreskin can become firmly adhered to the glans so retracting the foreskin (pulling it back) becomes difficult or impossible. This is called phimosis. Issues or concerns passing urine, painful erection and tight foreskin.

In summary, circumcision is the procedure which can be done under anesthesia with minimum risks of complications by professional trained doctors.

Ref:  surgical guide for circumcision 2012 DOI 10.1007/978-1-4471-2858-82

 

The Pollock Technique for newborn male circumcision

The Pollock Technique for newborn male circumcision

  1. Liquid infant acetaminophen is administered orally 20 minutes before the procedure

  2. The room is heated to 25 °C to help keep the newborn warm

  3. A parent (or guardian) accompanies the child into the procedure room to help calm him, if he is distressed

  4. The newborn is secured onto a soft restraining board wearing a clean diaper

  5. The parent gives a grape-juice-soaked cotton ball to the infant orally to help soothe the newborn during the procedure 2.5 ccs of 0.5% Xylocaine is administered into the dorsal and ventral nerves of the penis eight minutes prior to the circumcision

  6. Hemostats are used to open adhesions from the foreskin to the glans to the level of the corona

  7. Hemostats are placed about two-thirds of the way up the foreskin

  8. The Mogen clamp is applied over the foreskin using the pair of hemostats as a guide

  9. The foreskin is excised with the #23 scalpel T

  10. he glans is liberated Hemostasis is promoted with pressure applied with Coban tape over gauze with petroleum jelly

  11. A blanket is used to help comfort the infant The infant is assessed after 15 minutes.

Reference: Rapid Training and Implementation of the Pollock Technique, a Safe, Effective Newborn Circumcision Procedure, in a Low-Resource Setting. Global Pediatric Health January-December 2015: 1–7 © The Author(s) 2015 DOI: 10.1177/2333794X15589114 gph.sagepub.com

Notes: The Pollock Technique for newborn male circumcision in not different from Mogen clamp circumcision. Mogen clamp is commonly used for Jewish circumcision (brit milah). Other methods for baby circumcision are Gomco clamp circumcision and forceps guided circumcision. In my experience, these methods are not superior to Circumplast or Plastibell circumcision in newborn circumcision.

The complications specific to Mogen clamp circumcision (Pollock Technique) include injury to the glans if it is not below the inferior edge of the clamp, and an asymmetric incomplete circumcision due to malpositioning of the clamp (typically more redundancy ventrally).

Reference: Complications of Circumcision: TheScientificWorldJOURNAL (2011) 11, 2458–2468 ISSN 1537-744X; doi:10.1100/2011/373829)

Baby Circumcision- Frequently Asked Questions

Baby Circumcision- Frequently Asked Questions

frequently ask questions about baby circumcision

London Circumcision Clinic by Paediatric Surgeon/Urologist  

Adult feedback after Glue Circumcision

Dear Dr Khan and team

It is now 3 1/2 months since I attended the thorn hill clinic for my circumcision.

Everything has completely healed and I am very pleased and completely satisfied with the outcome. As is my girlfriend/partner.

When I got home on the day of the operation I took paracetamol as a precaution as the anaesthetic wore off. but that was the only time, I didn’t need it again. I went back to work on the Monday 15th October 2018.

The bandages came off after 3 days, the swelling had almost pushed them off by that point any way. I used the fuicuden cream as instructed but there was no infection so the antibiotic prescription didn’t get used.  Within 2 weeks the swelling had mostly gone down and by week 3 the stitches were gone.

I felt really looked after by you and your colleagues at the clinic, before, during and after the operation.

All in all a good experience (under the circumstance!!) I wish I had booked in with you for a circumcision years ago.

Kind regards

AW

( Email received on 27-01-2019)