Procedure

Neonatal Circumcision

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Neonatal Circumcision, Male Circumcision, Circumcision

  • Indications
  1. Routine procedure offered to parents in U.S.
    1. Supported by AAP as benefits outweigh risks
    2. Decision deferred to parental preference
    3. (2012) Pediatrics 130(3): 585-6 [PubMed]
  2. Jewish Tradition
  • Contraindications
  1. Chordee (ventral penile curvature)
  2. Hypospadias (abnormal ventral placement of the Urethral opening)
    1. Typically repaired with foreskin
  3. Buried penis (penis retracts into fat pad)
    1. Circumcision risks entrapping glans penis with post-procedure swelling
  • Efficacy
  • Benefits
  • Complications
  • Miscellaneous
  1. Granulation tissue
    1. May appear as yellow adherent scab
    2. Common, normal healing response following Circumcision
  2. Redundant foreskin (too little foreskin removed)
    1. Risk of Phimosis or poor cosmetic result
  3. Excessive foreskin removed
    1. Presents as denuded area of the distal penile shaft below the glans penis
    2. Typically heals spontaneously by epithelialization without complication
  4. Infection (uncommon)
  • Complications
  • Bleeding
  1. Management
    1. Initial measures
      1. Apply local pressure to area of bleeding for 5 minutes
      2. Apply Gelfoam wrap (speeds coagulation)
    2. Refractory bleeding
      1. Consult Urology
      2. Suture bleeding site
        1. Place superficial figure of eight Suture
        2. Exercise caution (especially on ventral surface) to avoid Urethral Trauma
          1. Suturing too deep can result in a urethrocutaneous fistula
      3. Consider blood dyscrasia
        1. Observe for Petechiae, Hematuria or bright red blood per Rectum
        2. Significant life-threatening bleeding may occur with conditions such as Hemophilia
          1. Circumcision related bleeding may be the initial presentation of Hemophilia
  2. Prevention of bleeding
    1. Avoid excessive manipulation of the penile frenulum (volar band at base of glans)
    2. Leave foreskin clamp (e.g. Gomco Clamp) on for 5 minutes during Circumcision
    3. Apply copious vaseline to Vaseline Gauze and leave applied to cut foreskin edge for 24 hours
  • Resources