Boy Circumcision in Uroklinik

 

What is required
According to the Danish National Board of Health guidance, there must be consent from both parents, or from him (her) who has parental authority. This applies to all boys under 15 years age.

On the operation day-Before surgery
We recommend that the child takes a bath before you come to the clinic, so the risk of infection is reduced.
Approximately 45 to 60 minutes before operation (Prior to coming to the clinic), you must apply a thick layer of anesthetic cream such as EMLA cream (http://pro.medicin.dk/Medicin/Praeparater/1070) or Tapin cream (http://pro.medicin.dk/Medicin/Praeparater/4271) to the root (basis) of the penis. Please see the picture. It is the dotted area on the penis to be lubricated and not on the foreskin.

This is to minimize pain when the child is going to get the right anesthesia (penile block) just before the operation.

Just before the operation
Prior to operation, 5 minutes before surgery, the child will get a penile block. This is done that the child will be injected in his penis, in that area which is lubricated with the anesthetic cream, so the injection will not be very painful.
After the penile block, the child will not feel pain at all when being circumcised. In many cases, specially infants, they will not be awakened during circumcision if they were sleeping.

EmlaSkitse

Methods of circumcision
There are many ways to do circumcision, but what we use in our clinic is by two methods:

The Ring-Plastibell method
Here we apply a plastic instrument (Plastibell) to the forskin.
With this method, ¾ of the foreskin will be removed (cut off) and the remaining ¼ of the foreskin will fall off with the ring or before.

The surgery takes about 7-10 minutes. We use this way only for small children, preferably under one year age and best 1-3 month old babies. The best age for circumcision with this method in our experience is 5-7 weeks old. We use the same procedure from time to time for the big kids who wear diapers, which is a requirement.

After parents’ wishes, we use once in a while the classic method for small children.

The Classic Old method, but in modern way
With this method, one cut virtually the entire foreskin and the surgeon have full control of how much exactly to be cut off. The bleeding stopped with electric coagulation and finally sewn both flip of the foreskin with an absorbable suture. The suture disappears after a unit time.

This process is used for the older children who do not go more with diaper.

Pain management
For the small children should be given paracetamol (paracetamol Junior) liquid or suppositories. (http://pro.medicin.dk/Medicin/Praeparater/670).
The recommended dose is 50 milligram per kilo weight in 24 hours. This must be dosed to 3-4 doses. Or about 15 milligram per kilo weight x3 times in 24 hours.

How to take care of a child after circumcision with the Ring-PlastiBell method

  1. Daily shower with plain water and neutral shampoo. First time the day after surgery.
  2. The diaper should be loose, preferably one size bigger for the child’s age, to avoid contact with penis.
  3. Each time the diaper is changed, the penis must be rinsed thoroughly with lukewarm water, wipe it and finally must penis head (Glans Penis) must be lubricated with a neutral cream as Locobase or neutral vasaline ointment.
  4. Be careful to not get pressure on the penis or ring.
  5. After the ring is dropped, then penis head (glans penis) is inspected, and if part of the foreskin covering the penis head, then the foreskin is pulled back to see the whole glans penis and then comes with a little baby powder on to avoid foreskin paste the penis head. It should be done every time you change the diaper and in a week’s time
  6. When the ring is dropped, you have to behave quite normally, like you have done before the child was circumcised.

When to react after Ring-PlastiBell method

  1. If a large part of the penis head (Glans Penis) comes out of the ring, then you should contact the clinic.
  2. The clinic must be contacted also by pronounced swelling and redness and fever.
  3. After the ring has fallen and observed that part of the foreskin is adherent to (attached to) the penis head so you must contact the clinic.
  4. Contact the clinic if there is bleeding.

How to take care of a child after circumcision by the classic method

  1. The child must have a shower the day after surgery, and during the bath, all patch (plaster) must be removed.
  2. The child must have a daily shower for 10-14 days.
  3. Whole the penis should be flushed with clean lukewarm water after each urination.
  4. The child must not go to swimming, or sit in the water the first 4 weeks after circumcision.
  5. The suture begins to fall off 14 days after surgery and at 6 weeks all the suture will disappear..
  6. If the penis head is partly covered by extra foreskin, then the foreskin must be pulled back toward the stomach to see the entire penis head (Glans penis).

It can take up to 6 weeks for the wound to heal completely.
When to react after circumcision by the classic method
when there is pronounced swelling of the penis and if there is leakage of pus between the penis head and foreskin and between suture.
Fever without finding a reason for it, for example. The child has a cold.

3-4 weeks after circumcision and if you observe that part of the foreskin is glued Attached to) on the penis head, then contact the clinic for advice.

You can always pick up a picture of the penis and send it as MMS to the clinic for advise.