1- Age and ideal age range for circumcision in boys:
Circumcision can be performed in any period except the age of 2-6, which is called the Phallic Period, when the child discovers his sexual identity. Making a painful attempt to the genital area during this period when the child discovers his or her genitals can lead to psychosexual and psychological problems in the future. Especially in this period, circumcision with local anesthesia is very harmful.
In circumcision operations I performed before the age of 2, since the recovery is faster during this period; I prefer the early period as I have observed that the child and the family get through this process more easily.
The only exception to all these age restrictions are children for whom we have given general anesthesia for another reason; In these patients, circumcision can be considered together with the procedure to be performed while they are under general anesthesia.
2- Advantages of circumcision performed early in infancy:
If you mean newborn circumcision (performed in the first 28 days), its advantages are not different from childhood circumcisions, but the skin is left too much, adhesion formation, the circumcision line narrows. I personally do not prefer to do newborn circumcision because it has some negative aspects such as healing and requiring a second procedure.
Newborn circumcisions can be performed under local anesthesia, but general anesthesia should be preferred in older children. In general anesthesia, the anesthetic with the shortest duration of action is preferred and mask anesthesia is applied. When the child sleeps, the procedure is easy, fast and bleeding control is more effective.
3- Urinary infection risk of circumcision performed in this period:
It has been proven by scientific publications that childhood circumcisions reduce the risk of urinary system infection, balanitis, phimosis, paraphimosis.
4- Diseases frequently seen in uncircumcised boys:
Urinary tract infections, balanitis, some sexually transmitted diseases and penile cancer are more common in uncircumcised men.
5- Diseases that circumcision reduces the risk in boys:
Circumcision also helps protect against penile cancer and some sexually transmitted diseases, including HIV. This issue has also been accepted by the American Academy of Pediatrics and the World Health Organization.
6- Undescended testis, its cause and treatment:
While in the mother’s womb, the eggs of the males, namely the testes, complete their development in the baby’s womb. After the 7th-8th months of pregnancy, they move through the inguinal canals and sit in the scrotum close to birth.
The failure of one or both testicles to fit into this bag is called “undescended testis”. It may take 4-6 months after the birth of the testicles to settle in the bag. After these months, if the testicles still have not descended into the bag, that is, if they remain in the canal or in the abdomen, surgical intervention is required.
The family may notice that the bag is empty, or the pediatrician may notice it during the routine child health examination.
The child whose testicles are not in the bag must be kept under control. The main complications of untreated undescended testis are infertility, cancer, and testicular torsion (rotation of the testis and impaired circulation).
Since the testicles must be located in bags, which is a cooler environment, for normal sperm production; If the testicle remains in the canal or abdominal cavity, the sperm producing cells begin to be affected due to the high temperature. After 18 months, the deterioration of the testis begins to become irreversible. For this reason, we now evaluate the fate of the testicles of a child who has reached the age of 1.5 and create our treatment plan.
In cases of undescended testis, which appear as small in size after a certain age, we may not be able to prevent loss of function even if we reduce the testis. These patients may need assisted reproductive techniques in order to have children in the future.
Treatment of true undescended testicles is surgical. The standard surgery is open surgery, called orchiopexy, which is performed in the groin. The testis is usually lowered into the bag in a single session, sometimes in two stages if it is in the abdominal cavity or if the vessels are very short.
In some cases where the testicles are close to the bag, hormonal therapy can enable the testicles to descend into the bag. However, drug therapy exposes children to sex hormones at an early age and can lead to various side effects. The main treatment in children with true undescended testicles is surgery.
8- Sunnah of the Prophet and its treatment:
In the disease, which is popularly known as the Prophet’s circumcision (Hypospadias) or congenital circumcision, urine comes from a hole on the underside of the penis. The urethra could not develop up to the tip of the penis and remained below. This condition may also be accompanied by curvature of the penis. Its treatment is surgery. The most appropriate age range for surgery is between 9 months and 1.5 years. The hospital stay can usually last 1-10 days, depending on the type of hypospadias and the surgical technique.
