A circumcision is an operation to remove the foreskin (the skin that covers the tip of the penis). You may have asked your surgeon to perform a circumcision for your child for cultural or religious reasons. This document will give you enough information about the benefits and risks so you can be sure you want to go ahead with the operation. If your surgeon has recommended a circumcision for your child for medical reasons, this document will give you enough information about the benefits and risks so you can be involved in the decision. If you think your child is mature enough, it is best to discuss the operation with them so they can be involved in the decision too. If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team.
Worldwide, circumcisions are most commonly performed for religious or cultural reasons. In the United Kingdom, circumcisions are usually performed only for medical reasons.like Balanitis xerotica obliterans (BXO),which is an uncommon condition where the foreskin becomes thickened and white, making it difficult to pull back. A non-retractile foreskin, where you are unable to pull back the foreskin despite advice and treatment from your child.s doctor.
The foreskin does not usually begin to retract until the child is between 6 and 10 years old. Recurrent infections of the foreskin. Circumcision is only needed if antibiotics and good hygiene fail to help. Abnormal urinary tract with urinary infection that keeps coming back. Circumcision may help to prevent infection because the bacteria lying between the foreskin and the tip of the penis may cause the infection.
If BXO is suspected, circumcision is the only dependable way to cure the condition. When BXO is not suspected, a nonretractile foreskin can often be treated with steroid creams. If your child does not have BXO, a dorsal slit operation or a preputioplasty may be recommended. These operations involve widening the foreskin but preserving it. Sometimes a circumcision will still be needed.
This depends on the reason why your surgeon has recommended a circumcision for your child. BXO can spread onto the end of the penis. However, even after surgery this may still happen. A non-retractile foreskin can interfere with sexual function later in life. However, the foreskin usually becomes retractile over time. Urinary infections may be more likely to keep on coming back.
The operation is performed under a general anaesthetic. If you want, you will be able to go with your child to the anaesthetic room. During the operation your surgeon will remove the foreskin and seal off any small blood vessels. They will stitch the two edges of skin together (see figure 1). You may be able to see these stitches but they will dissolve after a few weeks. You may be given ointment to apply to the wound after the operation. The penis usually looks swollen and red for the first week. This is a normal reaction to the operation.
The healthcare team will try to make your child.s operation as safe as possible. However, complications can happen. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of patients who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for your child. The complications fall into three categories.
1 Complications of anaesthesia
Your anaesthetist will be able to discuss with you the risks of having an anaesthetic.
2 General complications of any operation:
Pain, which happens with every operation. The healthcare team will try to reduce the pain. They will give your child medication to control the pain. It is important that your child takes the medication as you are told. Bleeding during or after surgery. This usually stops with pressure but your child may need another operation (risk: less than 1 in 100) and rarely a blood transfusion. Bleeding is more likely to happen if your child has a problem being able to form blood clots. It is very important to let your doctor know if your child, or anyone in your family, has this problem. Infection in the surgical wound (risk: 1 in 10). This usually settles if you keep the area clean and use anti-bacterial ointment.
However, your child may need antibiotics. Unsightly scarring of the skin.
a. Before the operation Foreskin
b. Cross-section before the operation
3 Specific complications of this operation:
Difficulty passing urine, which may need a catheter (small tube) but this is rare. Developing an ulcer at the tip of the penis (meatal ulceration). This is caused by the penis rubbing against underwear and usually settles. Narrowing of the opening of the urethra (meatal stenosis). This is caused by injury during the circumcision or inflammation afterwards and leads to difficulty passing urine. If this happens, your child may need a further operation (risk: less than 2 in 100). Too much foreskin is removed.
This is a rare complication which can lead to a buried penis. This is where the skin of the penis cannot be pulled down in the normal way over the shaft of the penis. If this happens, your child may need a skin graft. Not enough foreskin is removed,which may need a further operation (risk: 1 in 100). Damage to the urethra (urethral fistula). This is a rare complication and needs further surgery, usually about six months after the original operation. Injury to the end of the penis. This is a very rare but serious complication which needs specialist treatment. Cosmetic problems. It is difficult to predict exactly what the penis will look like after the circumcision. The penis may look unsightly, especially if other complications happen.
After the operation your child will be transferred to the recovery area and then to the ward. Your child should be able to go home the same day or the day after. However, your doctor may recommend that your child stays a little longer. If you are worried about anything, in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications. Returning to normal activities To start with, your child should rest and wear loose underwear.
Putting on plenty of Vaseline or nappy cream will help to prevent the penis (or the stitches) from sticking to underwear. The penis may look sore, swollen and bruised. Lukewarm baths may lessen the pain and also help to pass urine. Use simple painkillers such as Calpol or paracetamol for the first few days and encourage your child to drink plenty of fluids. It is usually possible to return to school between a week and ten days after the operation. Your child should avoid swimming for three weeks.
A circumcision is an operation to remove the foreskin. Surgery is usually safe and effective. However, complications can happen. You need to know about them to help you make an informed decision about surgery for your child. Knowing about them will also help to detect and treat any problems early.
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