Pain relief after newborn and baby boys circumcision

Lignocaine Gel- instillagel 2%

In addition to giving your child/young person painkilling medicine after circumcision, you will be given a tube of local anaesthetic jelly called instillagel to numb the area around the ring near the thread or the stitches. This may be used:

1. If your child is in pain after circumcision. 

2. If, before passing urine, your child/young person is frightened to do so.

3. After passing urine.

You will be shown how to apply the jelly in the clinic by Dr. Khan before your child/young person leaves the clinic after circumcision at London Circumcision Clinic. It is very useful for the first 24-48 hours in babies or a few days in children. It can be applied every  4 hours up to a maximum of 5 times a day. It works within 5 - 10 minutes and lasts for up to 45-90 minutes.

If you think your child/young person is in pain after circumcision, please give the painkillers as directed. Please be reassured that you will not overdose him if you follow these instructions, nor will he become addicted to the medicines. It is best to give the painkillers regularly for the first 2 - 3 days after the circumcision and then as needed:

● Paracetamol (Calpol, Disprol)
This can be given to your child/baby regularly 4 times a day for the first 2 days after going home, and thereafter as needed up to 4 times a day. Give amount as directed on the bottle or Dr Khan will calculate the dose for babies under 2 months old according to their weight. Paracetamol can be given under 2 months old child. 

● Ibuprofen (Junior Nurofen) over 3 months child 
Give this to your child/young person after circumcision as needed up to 3 times a day. It is safe to give both Ibuprofen and Paracetamol together, or alternate Ibuprofen with regular doses of Paracetamol.

● If your child/young person is asthmatic, it may still be safe to give them Ibuprofen as they may have had it in hospital. If you are worried about this, please talk to the nursing staff or doctors before you leave. If your child’s/young person’s asthma gets worse at home, stop using Ibuprofen, but continue with the Paracetamol as prescribed. Rarely, Ibuprofen can cause indigestion; if this occurs, stop using it but continue with Paracetamol. Follow the instructions on the bottle for drug dosage. 

Please ask Dr. Khan if you have any question.

 The content on the Our website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice from Dr. Khan regarding any medical questions or conditions developed after circumcision  

Please see uptodate about newborn circumcision information for parents. 

Newborn and baby boys circumcision by circumplast (modern Ring)

A review of first 1000 circumcisions in boys with a novel disposable ring in a community clinic.

Thornhill Circumcision Clinic, Luton and Leyton Clinic, London

PURPOSE

We evaluated postoperative complications in first 1000 circumcisions with a novel disposable ring, Circumplast, in a community clinic (London and Luton Clinic) for non-therapeutic male circumcision.

MATERIAL AND METHODS

We reviewed the outcome of first 1000 circumcisions performed with Circumplast device in children from May 2014 to October 2016 in a community clinic. Data were collected prospectively and all circumcisions were performed under local anaesthesia, by trained doctors with the backup of a trained paediatric surgeon. Early and late complications were assessed. Complications were further looked for under and over 3 months old. Follow-up consultation/visit were arranged if required.

RESULTS

The mean age of the patients was 11 ± 0.6 months (median 2, range 2 days to 11 years). The overall incidence of minor complications was 10% (n=101).

There is no major complication.

The outcome was significantly better in children under 3 months (7%, 39/554) over than 3 months (14%, 62/446) (p<0.05). Delay in ring separation is significantly lower in children under 3 months (0.3% to 2.9%) (p<0.05). Postoperative use of antibiotics for suspected infection was also significantly lower in children under 3 months (3% vs 7.4% n=17 vs 33) (P<0.05).

Post-operative bleeding (1%), preputial adhesions (1%), buried penis (0.6%), redo operations (0.7%), and urinary retention (0.01%) were recorded, but there was no significant difference in children under 3 months (P>0.05). Mean follow-up consultations were 16 days (range 1 to 373).

CONCLUSIONS

Non-therapeutic baby boys circumcision by the Circumplast device can be safely performed in a community clinic. This novel device decreases the risks of complication especially in children under 3 months of age.

Fisher Exact test, two tailed p value, <0.05 is significant, was done by Graphpad software

BXO phimosis- current practice

Our approach to the treatment of Balanitis Xerotica Oliterans (BXO) is aimed at eliminating occlusive contact of skin to urine, minimising urinary and sexual morbidity, abolishing the risk of progression to penile squamous cell carcinoma (PSCC) (by curing the inflammatory and scarring disease), with preservation of the foreskin if possible  If the condition is diagnosed early and interventions instituted promptly, disease progression and morbidity can be halted, and normality can be restored. Our medical treatment protocol involves avoidance of contact with urine by assiduously emptying the urethra after micturition (by shaking, squeezing, dabbing, and using barrier preparations), regular use of soap substitutes and barrier emollient creams and application of ultrapotent topical corticosteroids for a fixed, monitored period of time (usually clobetasol propionate). In addition, the short trimming of pubic hair is recommended in order to eliminate penile abrasion, irritation and inflammation. We avoid using topical calcineurin inhibitors due to the theoretical link with progression to SCC, but accept that this is controversial in BXO The mainstay of surgical management is circumcision.

If the above medical treatment regiment fails then circumcision is offered. Some patients may require further urethromeatal surgery. The success rates with medical therapy previously reported in the literature by us and others are in the range of 50-60%, whereas circumcision is thought to lead to cure in >75% of patients. Our results confirm the above; in isolated BXO, 50% of patients were treated successfully with medical therapy and foreskin preservation. The validity of the above treatment protocol is vindicated further by the outcomes of this study, with 91.7% having achieved resolution of symptoms, and the remaining either receiving ongoing medical therapy (4.8%) or waiting to undergo circumcision (3.5%). Side effects were minimal and mainly related to surgery.

Ref:

Journal of the European Academy of Dermatology and Venereology, Version of Record online: 16 AUG 2017