4. Follow Up
Your baby boy is going to have his circumcision. This operation involves removing the foreskin (prepuce) of the penis.
Worldwide, circumcisions are most commonly performed for religious or cultural reasons and are performed in the neonatal period (within 8 weeks). These circumcisions may be performed by obstetricians, religious representatives or general/ urological/ plastic surgeons.
The Portland Hospital offers an outpatient and an inpatient service for neonatal circumcision (babies up to the age of 8 weeks) performed by a paediatric urologist.
This service offered is as pain free as possible.
This is a very important aspect of your baby’s circumcision.
We take every measure to ensure that the procedure is as pain free as possible.
A local anaesthetic cream is applied to the base of the penis to numb the skin. It takes between 20 to 40 minutes for the cream to start working. This may be applied on your arrival or during the consultation. After this a local anaesthetic will then be injected prior to the circumcision through the numbed skin.
In our experience this offers a very satisfactory level of pain relief allowing the surgeon to perform the circumcision without causing any discomfort to your baby.
Babies are cuddled and held by experienced and skilled nurses from the operating theatre.
The plastibell (a bell shaped plastic device) will be used for your baby’s circumcision.
The following narrative refers to the diagrams above:
- Separation of inner foreskin from the glans (head of penis) all around.
- Making a cut in the foreskin.
- Pulling back the foreskin to expose the glans.
- (a) Placing an appropriate size of plastibell and drawing the foreskin over it.
(b) Placing a ligature (thread) in the groove on the plastibell.
- Removing the skin beyond the tied thread.
- Breaking the handle of the plastibell leaving the Plastibell device and a ligature on.
A rim of skin is left to avoid the ring falling off now.
This will gradually turn black and shrivel like the umbilical cord.
The penis above the circumcision site, in the diagram, will look slightly swollen and red until the ring falls off.
The plastibell device usually falls off after 2 and 8 days and it starts by splitting at the ligature level.
- The appearance of the penis after the ring falls off.
When the device falls off, the circumcision site will not look healed, until about a week later.
The plastibell circumcision is a relatively safe procedure but there are potential complications such as:
1. Bleeding from the surface of the tip of the penis.
This is seen as spotting on the nappy. This spotting is entirely normal and happens as the circumcision involves separating the inner layer of the penile skin from the tip (head/ glans) of the penis.
If you see continuous drops of blood contact us.
2. Device displacement
This may occur if the plastibell is too small or too large. If there is swelling of the tip of the penis and your baby is uncomfortable contact us.
3. Adhesions between the skin of the penis and glans.
4. Residual excess skin following circumcision.
Audit of the baby circumcisions done by Mrs Patil in The Portland hospital over the past year shows that there were no readmissions for bleeding, infection or other skin related problems like excess residual skin left or any excess skin removed. There were 2 babies who needed removal of the plastibell ring as the ring failed to come off on its own.
Auditnof the 115 babies circumcised in 2012 shows that 7 (5%) parents either called via telephone or came for followup.
Of the above 7 only 2 babies (1%) required retracting the penile skin adhesion to glans without an operation.
The remaining 5 (4%) out of 7 required reassurance only as there were no problems.
A routine follow-up is possible and you may discuss these arrangements with your consultant.
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