CIRCUMCISIONS
Before the Procedure
Before circumcision, the nurse will take history and vitals. The doctor will review the informed consent. This is a discussion of the circumcision, the benefits, risks,and ensures that the parents understand what will happen during the procedure. This is the time to ask any questions if you are not clear about any aspect of the procedure or aftercare.
METHOD
There are three commonly used methods. Safety is our top priority. Gomco clamp is the most widely used clamp and the safest of them all. The excess foreskin is completely removed at the time of the procedure; no tissue falls off or is removed at a later date. The bell protects the glans and urethra from injury during prepuce removal.
Other devices used like Plastibel (Plastic ring like device ) leaves the foreskin in place to fall off later is undesirable. While another clamp which is used, Mogen clamp, is simply not completely safe as it risks amputating the head of the penis.
PROCEDURE
Vital signs are noted and Tylenol is given to the baby. The infant is then placed in a restraint. The area of skin around the base of the penis is thoroughly cleaned. Local anesthetic (freezing) is applied and sugar solution is administered to pacify the baby. The procedure is done with minimal discomfort after the freezing has taken effect. Sometimes silver nitrate is applied afterwards to the bleeding points and this can make the skin darker grey in the area.
POST PROCEDURE
Petroleum jelly is applied to the diaper so that the penis does not rub on it. Some jelly can be applied to the penis as well. The baby is then returned to the parents. You are encourage to feed the baby as you wait a few minutes in the side room. A final check is made by the nurse before discharge.
CARING FOR A CIRCUMCISED PENIS
After the circumcision, you can comfort your baby by holding him and nursing him often.
The penis will take 7 to 14 days to heal. The area may be red for a few days and you may see some yellow discharge, which should decrease as it heals.
Follow the instructions given by the doctor about caring for using petroleum jelly, keeping the area clean and bathing.
Call your health care provider if:
You see persistent bleeding at any time during the healing process.
The redness and swelling around the circumcision do not start to go down in 48 hours.
Your baby develops a fever (rectal temperature of 38.0° C or higher).
Your baby seems to be unwell.
Your baby does not pass urine within 12 hours of the procedure.
There is a greenish or foul smelling discharge from the penis.
REFERENCES
Some reliable resources
Mayo Clinic: (US): https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550
WHO (World health Org): http://www.who.int/hiv/topics/malecircumcision/en/
Web MD: https://www.webmd.com/sexual-conditions/guide/circumcision
American Academy of Pead(US) policy statement: http://pediatrics.aappublications.org/content/130/3/585