Circumcision

What you need to know about circumcision:

Circumcision is the process of surgically removing the foreskin, called the prepuce, which covers the glans penis (head of the penis), in a certain shape and length, and exposing the tip of the penis. Phimosis unresponsive to treatment (foreskin adhesion), frequent urinary tract

infection, vesicoureteral reflux (back flow of urine from the bladder to the kidney), voiding disorder and balanitis (penis head infection) should be planned in the presence of paraphimosis (retraction of the foreskin and impaired blood supply in case of failure to perform it) should be done urgently. However, as in our country, circumcision is often performed for religious and sociocultural reasons.

Where, how and by whom medical intervention will be performed:

This operation will be performed locally by a doctor or under general anesthesia by a Pediatric surgeon in the operating room. The process usually starts with the cleaning of the area to be treated. The foreskin surrounding the tip of the penis is surgically cut (with scissors or scalpel), the inner skin of the penis, called the mucosa, is cut all around so that approximately 3-10 mm is left, and the remaining skin is sutured to the mucosa of the penis with absorbable sutures or adhered with some sterile chemical adhesives.

Estimated duration and success rate of the procedure: The duration of the operation is between 10-30 minutes under normal conditions, and this time may vary depending on the course of the operation and patient factors. The success of the procedure is considered to be the removal of the excess foreskin, and its success varies between 95-100%.

Expected benefits from the procedure: Benefits of circumcision; It provides continuous cleaning of the penis tip, prevents the transmission of diseases such as sexually transmitted syphilis, gonorrhea, herpes and AIDS and prevents the spread of these diseases, and protects it from cancers of the penis head and cervix.

Possible risks that may arise in case of refusal:

You can refuse to receive this treatment. Receiving this treatment is optional and if you refuse it will give you

There will be no change in our behavior towards you in the treatment applied or after that in our clinic. If there are possible risk factors that require circumcision (such as foreskin infection), it may progress and a subcutaneous abscess may occur. Frequent urinary tract infections can be seen, although rare, penile cancer may develop.

Possible complications of the procedure

No life-threatening complications are expected during and after the surgical treatment of this disease. However, in very rare cases, the following situations are possible.

Complications Due to General Anesthesia:

1. Atelectasis: Small areas of collapse can occur in the lungs, which can increase the risk of lung infection. This may require antibiotic therapy and physiotherapy.
2. Difficulty in intubation and need for tracheostomy: If the tube that needs to be placed from the mouth to the trachea for anesthesia cannot be inserted, it may be necessary to insert this tube (tracheostomy) through an incision made in the anterior part of the throat when necessary. This tube may need to be left on for a while after surgery, and some problems with this tube may develop over time.
3. Both local and general anesthesia carry some general risks. Any type of general anesthesia or sedation (sedation) has the possibility of causing some complications (negative outcome), although very rarely.

Complications of the surgery:

1. Bleeding: one of the most common complications. It is usually in the form of small hemorrhages and can be controlled with suppression of the bleeding site or local treatments applied to the area. Excessive bleeding occurs in 0.6% and can be treated by suturing. It is seen that the risk of bleeding is higher in circumcisions performed in cases that have taken aspirin or have bleeding disorders.
2. Infection: Its frequency varies between 0.2-0.4%. It responds well to antibiotic therapy.
3. Poor cosmetic appearance: It may occur as a result of insufficient cutting of the foreskin, as well as excessive cutting of the penis skin causes the penis to remain bare in terms of skin. A buried or tent penis may occur due to excessive skin excision from the penis body. Contracture develops as a result of insufficient cutting of the inner foreskin with excessive cutting of the penile body skin, and a condition called secondary phimosis may develop in these cases.
4. Penile amputation: Circumcision-related amputation is rare, but cutting of the glans tip is not uncommon. It is especially common in traditional circumcisions performed with clamps. Amputation requires reimplantation, while amputation of the glans tip is treated conservatively.
5. Urinary retention: It can lead to obstruction in the urinary tract due to tight bandage after circumcision. In older children, pain and fear can lead to urinary retention.
6. Psychological disorders: It occurs frequently, especially between the ages of 3-6 and/or after circumcision performed under inappropriate conditions.

Lifestyle recommendations critical to the patient’s health:

Especially in the first week, excessive activities and movements that may cause direct trauma to the penis should be avoided. Afterwards, the patient does not need to make any restrictions or changes in his lifestyle.

Medications to be used after the procedure and important features:

The penis wrap is usually removed on the second day after circumcision. Even if local anesthesia is given, your doctor may give you nonsteroidal anti-inflammatory or paracetamol group pain relievers as pain relievers. In addition, it can give locally applied creams and pomades to be used after the dressing is opened. Blood thinners such as aspirin should not be used. Physician control is required one week after circumcision.

How to reach medical help on the same issue when necessary: ​​In case of emergency, one can apply to the emergency service of our clinic outside of working hours.

*All your medical and identity information of the patient will be kept confidential and your identity information will not be given even if it is published in researches, but pollsters, ethical committees and official authorities can access your medical information when necessary.

*Clinical information may be reviewed from your medical records for the advancement of medical work, medical research and physician education, provided that patient confidentiality rules in the patient rights regulation are adhered to. Research results can be published in the medical literature as long as patient confidentiality is maintained. You may not agree to participate in such a study, in which case the treatment will not be adversely affected in any way.

*Photo/Audience: The surgery to be performed, including the appropriate parts of the body, can be photographed or video recorded for scientific, medical or educational purposes. At the same time, qualified observers can be recruited into the operating room during surgery to improve medical education.

Short Notes about CIRCIUS:

• There is an infection under the foreskin. The foreskin cannot be opened completely and there is a white discharge.

CIRCUMCISION

• Local (regional) anesthesia is applied.
• After anesthesia is provided, the operation area is cleaned and sterilized. It is the removal of the skin fold at the tip of the penis, which covers the urine exit hole and creates a closed space in that area. After the bleeding is stopped, the remaining parts are combined and sutured.

What can happen if the attempt is not made?:

• Foreskin infection may progress. Subcutaneous abscess may occur. Although rare, penile cancer may develop due to frequent infections. Advanced surgical and medical treatments may be required.

• Phimosis unresponsive to treatment (foreskin adhesion), frequent urinary tract infection

urinary incontinence, vesicoureteral reflux (backflow of urine from the bladder to the kidney), voiding disorder and

paraphimosis (back of the foreskin), planned in the presence of balanitis (penis head infection)

In case of withdrawal and failure to fulfill the blood supply, it is urgently

is required to be done.

• The success of the procedure is considered to be the removal of the excess foreskin. % success of the operation

It varies between 95-100.

There are some risks/complications of this Operation and these are listed below.

COMPLICATIONS

• After the operation, edema and bleeding may occur in the area where the procedure is applied. In this case, additional treatment can be applied (< 0.1%).
• If edema and bruising occur in the anesthesia area, it will disappear over time.
• Infection (very rare) may develop. In this case, antibiotic therapy can be applied.