CIRCUMCISION INFORMATION SHEET REDGUM SKIN CANCER CLINIC 174 Hancock Rd Ridgehaven SA 5097 Ph 08 83963398 email:[email protected] 1. The Procedure 2. Methods 3. Infants and Children up to 10 years 3a Post Operative 3b Possible Complications 3c Instructions to Parents 4. Children 10 years through to Adults of any age. 4a Post Operative 4b Possible Complications 5. Benefits to Health 6 Fees and Medicare Item Numbers
1. The Procedure
This operation is the surgical removal of the foreskin of males - infants, children and adults.
2. Methods
We use two different methods depending on age -
For infants and children up to approximately 10 years of age - we use the plastibell method.
For children 10 years and above through to adults, doctor uses the free-form surgery method involving hand stitching.
The patient (patients under 16 require parental consent) is required to have an initial consultation with our doctor to discuss the procedure. Following this consult, the procedure appointment can be booked.
3. Infants and Children to 10 years old
Local anaesthetic is used for this procedure, however Emla local anaesthetic cream is applied at our Clinic one hour prior to the procedure and is held in contact with the skin using plastic wrap. This numbs the skin for administration of the local anaesthetic injections at the commencement of the procedure. (The Emla cream is not used on infants under 3 months at this clinic.) We allow 30 minutes for the procedure. We supply parents with chloromycetin eye ointment to use on the healing skin 3 times per day applied using a finger or a cotton bud. Although infection is uncommon, use of this ointment reduces the likelihood of infection even more so.
3a Post Operative
The plastibell, ligature and remnant of foreskin should all come off by itself in about 7 to 10 days.
Bathing - the patient can be bathed once daily as usual with a small amount of liquid soap. More frequent bathing is associated with increased risk of infection. Pain Relief - the majority of babies/children need no pain relief whatsoever as the local anaesthetic takes a few hours to wear off. Occasionally, the patient will cry or be unsettled for a short while at this time and usual analgesia as appropriate for the age of the child may help.
3b Possible Complications
Generally, circumcision at a young age is a straight forward trouble free procedure within minimal interference in baby's routine but there are a few rare problems that parents should know about. Infection -Should a baby boy develop infection, he is likely to need injections to treat this, as antibiotics by mouth in the very young are not well absorbed. Infections in older boys can usually be treated with oral antibiotics. On very rare occasions the plastibell is removed early to reduce inflammation. Bleeding - This occurs in about one in 300 circumcisions. Should this occur parents must contact the clinic. We provide after hours phone contacts. Bruising - The local anaesthetic needle can cause a little bruising that takes a day or two to disappear and is of no consequence. Serious bruising is very rare (one per thousand) but has not been detrimental to the final result. Plastibell slipping down - this is a rare problem and relates to the size of the plastibell used. We do our best to ensure the correct size is used making this a very unlikely problem. Should the plastibell slip down over the glans it may become like a ring that is too tight. This may be a medical emergency and needs to be corrected. Foreskin reforming - on rare occasions, it is possible for the skin as it heals to form a miniature foreskin that can scar up and be hard to pull back. This is a rare problem and the only solution is usually recircumcision.
3c Instructions to Parents
It is preferable to meet face-to-face well before the procedure but due to distance, we can do the interview/consultation by phone and just prior to the operation, if the patient lives interstate or in remote parts of our State. Babies should be fed (but not overfed) immediately prior to the procedure. (They tend to cry otherwise.) Some parents stay in for the operation but it depends what you are comfortable with. After the procedure parents should check for bleeding every hour for the next 3 hours. There should be no bleeding whatsoever. Folks from afar are asked to remain in the
vicinity of the clinic for at least an hour so that it is easier to return should there be any concerns. Nappies can be used as normal.
Babies/children should be bathed normally once per day. There is an increased risk of infection with bathing more often. Once the plastibell comes off the penis should look like the usual circumcised penis. Parents should report any increasing swelling or inflammation. As with any operation, some minor redness and swelling is expected as the skin heals.
4. Children 10 years and above, through to Adults
After the initial consultation with our doctor, the procedure appointment can be booked through our clinic reception staff. We can usually offer an appointment within 2 - 4 weeks. Children under 16 require parental consent. Doctor uses local anaesthetic. Once good anaesthesia is attained the amount of excess foreskin is determined and surgically removed and the remaining tissue rejoined by dissolving handstitches. We allow one and a half hours for this procedure.
4a Post Operative
The local anaesthetic used in this procedure usually lasts several hours and over the counter pain relief, appropriate to the age of the patient, is recommended as required over the next few days. As dissolving stitches are used in free form circumcision surgery, patients can expect stitch remnants to come away after 10-14 days. Time away from normal activity is variable but usually 2 to 7 days.
4b Possible Complications
Bleeding/bruising - Minor bleeding on to the dressing is not uncommon. Significant bleeding should be reported to the clinic. Infection - this is rare, patients should report any increasing redness and tenderness. Wound breakdown - This is quite uncommon but best managed with dressings. It may take several weeks for skin to heal across the wound.
Unsatisfactory cosmetic result - should the patient and the doctor agree that the circumcised appearance has not been obtained, further foreskin can be removed.
5. Benefits to Health
There are certain well recognised health benefits provided by circumcision besides the obvious ease of hygiene. Urinary tract infection - this is not a common illness in boys but is very rare in circumcised males. Sexually transmitted diseases - in third world countries studies suggest that heterosexual transmission of HIV is less common with circumcised men. Phimosis - This is scaring of the foreskin to the extent that it cannot be pulled back over the glans. This is a common reason to request circumcision as an adult. 6. Fees
The initial consultation fee, regardless of age of the patient, is $55.00 After Medicare rebate of $36.30, leaves an out of pocket gap to the patient of $18.70. Infants under 6 months on day of the procedure - $400.00. Medicare rebate is $39.55. Children 6 months to less than 10 years - $500.00. Medicare rebate is $91.95 Children 10 years old through to any aged adult - $1250.00. Medicare rebate is $127.30.
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