ADEQUATE PERI-OPERATIVE MANAGEMENT DECREASES COSMETIC COMPLICATIONS AFTER CIRCUMCISION WITH DISPOSABLE RING IN CHILDREN

Dr. Khan will present our results in his poster presentation at Barcelona, Spain on ESPU Meeting on Friday 21, April 2017. 

"We reviewed our experience in treating children with cosmetic complications following non-therapeutic male circumcision (NMC) with Plastibell and Circumplast devices at a community clinics ( Thornhill Clinic, Luton, Leyton Clinic, Leyton and Croydon London Clinic). This study highlights the factors leading to these complications and clinical management to improve the cosmetic appearance

A retrospective review of 3360 children who underwent Circumplast (CC) and Plastibell circumcision (PC) under local anaesthesia at the community clinics from May 2014 to October 2016. "

Ideal age of circumcision in children

Our audit at Thornhill Circumcision Centre, Luton, Bedforshire

incidence of complications in circumcision for 6 months olds is significantly lower when compared to 6 to 110 months old children.  We can conclude that under 6 months is the optimal age for non-therapeutic male circumcision in a community clinic using Circumplast and Plastibell devices.

Methods of Adult and older boys Circumcision

Dorsal slit method: 

The dorsal slit method for circumcision is mainly used for phimosis (tight foreskin) and paraphimosis. After a partial dorsal slit, the surgeon needs to identify the corona of the glans to cut the correct amount of foreskin.  

Sleeve method  

Freehand cutting of the skin

Forceps guided method  

Use of forceps to cut the foreskin.

Freehand method  

cutting with scissor  

Shang Ring 

disposable clamp to use  

Glue vs stitches circumcision

glue to apply to skin edges.  

Why biopsy is important in adult with balanitis xerotica obliteranes (BXO) or lichen sclerosis foreskin in phimosis (tight foreskin)

There are some association of skin cancer with BXO. In one of the series, incidence of skin cancer is reported 5.8%.  

In other series, incidence of BXO found adjacent to penile skin cancer is 33%. These findings raised a question whether BXO is pre-malignant condition. 

It is important to do biopsy of all BXO or lichen sclerosis foreskin to confirm the diagnosis and to rule out the concomitant skin cancer. Dr. Khan sends all foreskin with BXO for biopsy after the circumcision. 

Circumcision is strongly indicated if your foreskin shows signs and symptoms of BXO or lichen sclerosis which is causing tight foreskin. 

The British Association of Dermatologists has issued a guideline about MALE GENITAL (PENIS) LICHEN SCLEROSUS