Would circumcision usually be performed by a male or female doctor? Can anyone tell me what the process is?

Original author:

1. The people who need to be circumcised are:

1. Children with phimosis have obstruction of urination or repeated infections due to the narrow opening of the foreskin sac.

2. Adults suffering from phimosis or redundant foreskin and repeated infections.

Phimosis in childhood is normal. Infants with phimosis or children with foreskin should not undergo circumcision if there are no complications. This is because phimosis in children under 3 years old usually disappears with age; in other children, as long as the foreskin is repeatedly retracted upward and the foreskin opening is expanded, the glans penis will be exposed, and surgical removal is not necessary.

2. The surgical process:

[Preoperative preparation]

1. The night before and on the day of surgery, instruct the patient to clean the area.

2. Those who are complicated by foreskin and balanitis need to be treated with drugs and local immersion. Surgery can be performed after the inflammation subsides.

[Anesthesia]

Local anesthesia or corpus cavernosum anesthesia; basic anesthesia can be added for children [Figure 1 ⑴ ⑵].

[Surgical steps]

1. Position: supine position.

2. Cleaning and disinfection: Use soapy water and salt water to clean the local area, and disinfect with 1:1000 Xinjierzao solution; for patients with phimosis, use a syringe connected to a venous incision needle to inject Xinjiaerzao solution into the foreskin sac for disinfection.

3. To separate adhesions, if there is stenosis of the foreskin orifice and adhesions between the foreskin and the glans penis, first use hemostatic forceps to expand the foreskin orifice, and then use two hemostatic forceps to clamp the middle part of the dorsal edge (the distance between the two forceps is 0.2cm) ) [Figure 2 ⑴]. Use a grooved probe to separate adhesions until the glans penis and foreskin are completely separated [Figure 2 (2)]. Then clean the foreskin sac and glans penis with sterilized saline.

4. Design the incision. Use a pair of hemostatic forceps to clamp the foreskin frenulum to lift the foreskin. Use the tip of the knife to make an incision on the outer plate of the foreskin 0.5 cm distal to the edge of the coronal sulcus to prepare a circumferential incision to prevent excessive resection.

5. Dorsal incision Use scissors to cut the inner and outer plates of the foreskin along the probe groove. The inner plate of the foreskin should also be cut to about 0.5cm away from the edge of the coronal groove [Figure 2 (3)].

6. Excise the foreskin. Align the inner and outer plates of the foreskin, pull out the hemostatic forceps clamped on the dorsal side of the foreskin and the frenulum, and then recheck whether the incision on the outer plate of the foreskin is appropriate as a circumcision incision. If appropriate, use curved scissors to cut off the right skin flap along the incision about 0.5cm away from the coronal sulcus [Figure 2 (4)], and then cut off the left side. The inner and outer plates of the foreskin frenulum may not be cut off, or more may be left [Figure 2 ⑸].

7. Stop bleeding. Pull the skin of the penis upward to stop the bleeding after revealing the blood spots. Special attention should be paid to ligating the superficial dorsal vein of the penis in the middle of the dorsal side of the penis [Figure 2 ⑹].

8. Suture: Use thin silk thread to sew one stitch each on the back, abdomen, left and right sides of the circular incision. The ligation should not be too tight to avoid strangulation of the skin when the tissue is edematous. The sutures are not cut short and are left to hold the dressing in place. Then use 1 to 2 stitches between every two stitches, and the needle should pass out close to the incisal edge [Figure 2 ⑺].

9. Bandaging: Wrap a piece of Vaseline gauze (with the raw edge folded inside) around the foreskin incision, secure it with a long suture, and then wrap it with several layers of gauze [Figure 2 ⑻].

[Intraoperative Precautions]

1. During circumcision, the broken ends of the blood vessels between the inner and outer plates often retract proximally and must be found and ligated. Otherwise a large hematoma can form.

2. Do not cut the foreskin too much to avoid painful penile erection. Generally, the inner plate of the foreskin should be cut to about 0.5cm away from the coronal sulcus. The frenulum should not be left too small either.

[Postoperative treatment]

1. Take sedatives before going to bed within 3 to 4 days after surgery to prevent penile erection, which may cause pain and bleeding.

2. Inform the patient not to wet the gauze when urinating.

Figure 1 Cavernosal anesthesia

⑴ Subcutaneous anesthesia at the base of the penis and both sides of the corpus cavernosum

⑵Anesthesia of the cavernous urethra

Figure 2 Circumcision

⑴Use hemostatic forceps to pick up the dorsal foreskin

⑵Use a grooved probe to peel off foreskin adhesions

⑶Along the probe groove Cut the foreskin

⑷Circumcise the foreskin 0.5cm away from the coronary sulcus

⑸Preserve more of the foreskin at the frenulum