A circumcision (synonyms: Circumcision; circumcision of the foreskin; foreskin circumcision; foreskin removal) is the partial or complete removal of the male foreskin.Phimosis is the constriction of the penile foreskin (lat. : praeputium), as a result of which it cannot be pushed back.Phimosis can occur congenitally or acquired. In infants and young children, it must be distinguished from adhesion of the foreskin, which occurs physiologically (naturally).It can lead to obstruction of micturition (urination) and erection. Note: In 10-35% of children still have physiological phimosis after the age of 3 years; about 1% of 16-18 year olds have pathological (pathological) phimosis. CONCLUSION: Spontaneous foreskin release can be waited until puberty.
Indications (areas of application)
- Phimosis
- Lichen sclerosus et atrophicus affecting the penis (therapy of choice).
- Cultural reasons
Before the operation
- Hair removal – the removal of bothersome hair on the penile shaft and in the groin region is of important significance in infection prevention. However, it should be noted that the avoidance of skin irritation should be done.
- Cleaning and disinfection – before the operation, the nurse or the patient should clean the genitals. Prior to surgery, skin disinfection is performed by pushing back the foreskin to ensure adequate germ reduction in the surgical area.
- Anesthesia – depending on the age, health condition and individual desire, the choice of anesthesia procedure is made. There is both the option to produce local anesthesia (local anesthesia) through a penile block and to perform a more elaborate spinal anesthesia. Since circumcision of the foreskin is often performed in childhood, general anesthesia is often the procedure of choice. With the help of a penile block, it is possible to achieve a reduction in anesthetic medication. In addition to significantly reducing the need for medication during the procedure, postoperative pain (after surgery) can also be significantly reduced.
The operation can be performed under local anesthesia, spinal anesthesia or general anesthesia. It is usually performed on an outpatient basis.circumcision is a safe procedure to avoid complications of phimosis. It can also be performed prophylactically after detailed informed consent.
The surgical procedure
- During circumcision, the foreskin (praeputium), which is pulled forward and protrudes over the glans penis, is first grasped with a clamp and separated by an incision in front of this plane protecting the glans. As a rule, the skin ring (inner foreskin sheet) remaining between this incision and the glans corona is then additionally shortened.
After the operation
- Sitz baths – already from the first day after performed foreskin circumcision is indicated to perform sitz baths with tannin-containing additives (anti-inflammatory substance). Furthermore, it is important to retract the remaining foreskin to achieve adequate cleaning and minimize the risk of infection.
- Pain relief – depending on the age, different medications must be taken to relieve pain:
- Children are given paracetamol preparations, as they are associated with few complications.
- For patients outside childhood, other analgesics (pain relievers) such as acetylsalicylic acid (ASA) or ibuprofen may be used.
- Wound control – wound checks should be performed frequently, with the first check after about three days. In addition to the checks, increased parental attention is necessary during the first weeks after surgery, so that in case of symptoms such as fever or redness, it is possible to visit the doctor immediately. Wound infections are to be avoided at all costs, as these can be associated with serious secondary complications.
Possible complications (in children about 5%)
- Wound healing disorders and wound infections
- Bleeding
- Nerve or vascular damage
- Decrease in sensitivity to erogenous stimuli
- Erectile dysfunction (erectile dysfunction)