Circumcision
Alternative names:
foreskin removal; excision of penile foreskin; removal of
foreskin
Definition:
Surgical removal of the foreskin of the penis.
Description:
Circumcision of a newborn boy is usually done before he
leaves the hospital. A numbing medication (local anesthesia
such as Xylocaine) is injected into the penis
to reduce pain. Ring-type clamps are placed around the foreskin,
tightened like a tourniquet to reduce bleeding,
and the foreskin is removed below the clamp. The clamp may
be metal or plastic (Plastibell). The Plastibell will fall
off in 5 to 8 days, after the surgical site has healed.
Circumcision of older and adolescent boys is usually done
while the child is completely asleep and pain-free (using
general anesthesia). The foreskin is removed and stitched
onto the remaining skin of the penis. Stitches that will dissolve
(absorbable sutures) are used and will be absorbed within
7 to 10 days.
In the U.S. circumcision of a newborn boy is usually done
before he leaves the hospital. Among the Jewish population
circumcision is done on the 7th day. The status of circumcision
is currently under debate. There is not a compelling medical
rationale for circumcision. Neither is there a compelling
reason not to circumcise. Many physicians, rather than routinely
recommending circumcision, allow the parents to make the decision
after presenting them with the 'pros' and 'cons' of circumcision.
In the newborn, a numbing medication (local anesthesia such
as Xylocaine) is injected at the base of the penis
to reduce pain. The procedure is then accomplished with a
metal Ring-type clamp or a plastic ring device (Plastibel).
The foreskin is freed from the head of the penis (glans) and
a bell-shaped device placed over the glans. With the metal
device the foreskin is clamped and excised and the metal device
removed. The circumcision heals in 5-7 days. With the plastic
device a piece of suture is tied tightly around the foreskin
crushing the tissue into a groove in the plastic bell placed
over the head of the penis. The excess foreskin is clipped
off . Within 5-7 days the plastic bell covering the penis
falls free leaving a completely healed circumcision. Circumcision
of older and adolescent boys is usually done while the child
is completely asleep and pain-free (using general anesthesia).
The foreskin is removed and stitched onto the remaining skin
of the penis. Stitches that will dissolve (absorbable sutures)
are used and will be absorbed within 7 to 10 days.
Indications:
The common indication for circumcision is cultural or religious
desire for circumcision. At the present time the American
Academy of Pediatrics is not recommending routine circumcision
for newborn males. However, a recent study of a large number
(14,893) of male newborns revealed that 86% of the uncircumcized
infants developed a urinary tract infection under one year
of age, which led to a higher health care cost and hospital
days than in the circumcized group. Previous older studies
have also shown the relationship between uncircumcized male
infants and an increased incidence in urinaty tract infections.The
age old practice of male infant circumcision still must remain
the decision of the parents.
Other indications (rare):
- treatment for inability to pull back the foreskin completely
(phimosis)
- infection of the penis
(balanitis)
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
editorial
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