Circumcision

Circumcision

Q 1. What is circumcision?

A. Circumcision involves surgical removal of the foreskin and is indicated for disease or tightness of the foreskin itself.

Circumcision

Q 2. What are the alternatives to this procedure?

A. Drugs to relieve inflammation and avoid circumcision. However medical therapy is not effective in majority of situations.

Q 3. What should I expect before the procedure?

A. You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

  • Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
  •  Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
  • Presence of implants, pacemakers, graft etc
  • You are taking prescription drugs like-
    • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
    • Anti-epileptics like phenytoin, valproate etc

Q 4. What happens during the procedure?

A. A full general anaesthetic (where you will be asleep throughout the procedure), a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) or a local anaesthetic injection around the penis may be used. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you. Local anaesthetic is also injected into the base of the penis to aid pain control after the operation; this can be used as the sole form of anaesthesia in some patients.

The entire foreskin will be removed using an incision just behind the head of the penis. This leaves the head of the penis completely exposed with no redundant skin.

Q 5. What happens immediately after the procedure?

A. You may experience discomfort or pain for a few days after the procedure. You will be prescribed painkillers for the same. This procedure is done using absorbable stitches which do not require removal.

Ointment as prescribed should be applied to the tip of the penis and around the stitch line to prevent the penis from adhering to your underclothes and it is advisable to wear light clothing for two to three days.

Passing urine will be painless and will not be affected by the operation.

The average hospital stay is one day.

Q 6. What are the side effects?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

  • Swelling of the penis lasting several days

Occasional (between one in 10 and one in 50)

  • Bleeding of the wound occasionally needing a further procedure
  • Infection of the incision requiring further treatment and/or casualty visit
  • Permanent altered or reduced sensation in the head of the penis
  • Persistence of the absorbable stitches after three to four weeks, requiring removal
  • Rare (less than one in 50)
  • Scar tenderness
  • Failure to be completely satisfied with the cosmetic result
  • Occasional need for removal of excessive skin at a later date
  • Permission for biopsy of abnormal area on the head of the penis if malignancy is a concern

Q 7. What should I expect when I get home?

A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.

It will be at least 10 days before healing occurs and you may return to work when you are comfortable enough and your urologist is satisfied with your progress.

Most people require at least a week off work. You should refrain from sexual intercourse for a minimum of four weeks.
It will take at least 10 days to recover fully from the operation. You should not expect to return to work within seven days.

Q 8. What else should I look out for?

A. There may be some swelling of the penis after a few days. This may last three to four days and will then subside but do not be alarmed because this is expected.

However, if you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.

Q 9. What all can I do after my discharge?

A. Give your body a rest during the first week after the procedure. Be careful lifting heavy objects and doing strenuous exercises. Wear loosely fitting and comfortable undergarments.

Q 10. When to contact my doctor?

A. When you have:

  • Fever higher than 38.5 degrees; Nausea and vomiting
  •  Increased redness, throbbing or drainage at the site of the operation
  •  A serious burning sensation (not mild) when urinating
  • Inability to urinate
  • Tell your doctor right away if bleeding or pain is severe or if problems last longer or worsen after you leave the hospital.

Q 11. What is the follow-up after surgery?

A. A follow-up appointment will be scheduled with you prior to discharge from the hospital. This appointment might be necessary for examination of the stitch line.