Circumcision-Indications and Operative Surgery Steps

Circumcision

Circumcision is An Operative procedure

                           -which reduces the chance of Ca Penis

                           -which reduces the risk of transmission of HIV

Indications:

                  1.True Phimosis( due to Balonitis Xerotica Obliterans-BXO-Lichen Sclerosis – Sclerosing Inlfammatory Dermatosis- resultinfg in scarring of prepuce & prepuceal aperture becomes tight )

                   Physiological adhesion between the fore skin and the glans penispersist until 6 years of age 

                2.Paraphimosis( Failure of retracted foreskin to return to its original position over glans penis)

               3.Religious ( Most common)

              4.Recurrent balanoposthitis( Diabetes)

              5.Prior to Radiotherapy for Ca Penis

Anesthesia: Local / General

Position of the Patient: Supine

Incision:

                  Prepuce is divided in the midline dorsally up to corona &  the incision is extended circumferentially across the prepuce  5 mm beyond and parallel to corona.

Step 1. Three artery forceps are applied at 2, 6 & 10’ O clock position.

Step 2. Adhesion between prepuce and glans are released up to corona.

Step 3. Between the artery forceps at 2 and 10’ O clock position the prepuce is incised at 12’ O clock position up to corona.

Step 4. The outer skin and inner skin over the glans are cut all around anddivided parallel to corona leaving a ‘ v ’ shaped flap at the frenulum.

Step 5. A figure of 8 suture is placed over the frenulum ( As it contain the Arteryof Frenulum)

Step 6. Inner skin is sutured to the outer skin of prepuce with 2 0 absorbable interrupted sutures. 0.5Cm Inner skin has to be there to prevent the disfigurement