Circumcision is the most common surgical procedure applied to children in our country. It is performed by cutting the foreskin (prepisium) surrounding the head of the penis (Glans). Although circumcision is mostly done with religious and cultural considerations, its frequency is increasing day by day considering its medical benefits.
Conditions that require circumcision: The narrow tip of the foreskin (phimosis) is among the most common medical reasons for circumcision. Circumcision is necessary if the child has difficulty urinating and even if the foreskin inflates like a balloon.
Inability to re-correct the foreskin due to edema and stenosis (paraphimosis) after it has been scraped back is one of the conditions requiring urgent circumcision.
Circumcision is recommended in recurrent urinary tract infections. Circumcision is also recommended in children with urinary leakage from the bladder to the kidneys (vesicoureteral reflux) or enlargement of the kidneys (hydronephrosis) to reduce the risk of urinary tract infection.
Circumcision should not be performed: In structural diseases of the penis, circumcision is performed together with the actual surgery and should not be done beforehand. Circumcision is not performed in children with hypospadias (urinating under the penis), because the foreskin can be used during surgery. Apart from this, circumcision is not performed beforehand in cases of epispadias (open penis), buried penis, and the penis is attached to the bag (webbed penis).
Premature (premature born) babies and children with bleeding disease should only be circumcised at appropriate times and conditions.
Things to do before circumcision: We recommend that the child be examined by a doctor before circumcision, so that regional and other diseases such as structural abnormalities in the penis, hernia, undescended testicles that may be overlooked are checked.
The ideal age for circumcision is frequently asked. It is important that the ideal approach according to the age is more important than the ideal age. Circumcision should not be performed under local anesthesia at certain ages, especially between the ages of 2-5. Circumcision can be easily performed with general anesthesia, that is, by anesthetizing, so that the child does not experience stress and fear at these ages and at other ages. Local circumcision can be performed in the neonatal period, that is, in the first 1-2 months after birth.
Type of anesthesia in circumcision:
Local anesthesia is performed by administering a local anesthetic drug with a needle around the penis. Circumcision can be performed with local anesthesia in the neonatal period and in older children who are compliant and prepared.
Circumcision under general anesthesia is performed while the child is completely asleep. In this way, the child does not experience anxiety, stress, distress and restlessness due to the surgical procedure or the operating room environment. The child is evaluated by the anesthesiologist, a blood test is performed, and he should be fasting for 3-8 hours, depending on the age, before the circumcision procedure.
Circumcision techniques:
The cutting of the foreskin can be done surgically, by cautery (electric soldering iron or laser) and crushing with plastic clips. The surgical method is performed by cutting the foreskin around the glans in a measured manner and suturing the skin and mucosa with a thin absorbable suture. The healing and results are very good in frequently applied and competent hands. In addition, with this method, it is possible to perform additional procedures such as frenyloplasty (correction of the ligament under the glans), correction of slight curvatures in the pipi connected to the skin. Although this process takes a little longer than other methods, it meets the desired fast and smooth healing and ideal cosmetic results. Although the clip method and cautery are easy to process, burns due to cautery or delayed healing and thick scar tissue can be seen in clips.
Circumcision environment: Circumcision is an important surgical procedure and ideally it should be performed in the operating room. In circumcisions performed outside the operating room or an equivalent clean environment, the risk of infection will be very high and wound healing will be delayed. It should be noted that circumcision is still one of the surgical procedures with a high complication rate.
What to do after circumcision: Children with diapers after circumcision usually do not need bandages, it is sufficient to apply plenty of antibiotic cream on the pipi at every diaper change. The treatment is completed by applying more cream for the first 2 days and then less cream for 5 days. The child can be washed on the 2nd day after the circumcision, and washing the penis with plenty of warm water in the morning and evening for 5 days helps to heal.
In older children, after circumcision, it may be wrapped around the pipi with antibiotic cream gauze or a transparent tegaderm such as gelatin. The bandage is opened on the second day and continues to use antibiotic cream, can take a bath, and wash with plenty of warm water in the morning and evening for 5 days.
Benefits of circumcision: There are studies reporting that circumcision reduces the risk of urinary tract infections in children. It is seen that after circumcision, babies urinate more easily and the risk of regional infections such as balanitis decreases. In addition, it has been reported that it reduces the incidence of sexually transmitted diseases in older ages, and reduces the risk of penile carcinoma and cervical cancer (cervix uterine carcinoma).
Complications of circumcision:
Circumcision is an easy-care surgical procedure with a very low risk when performed by competent hands and under appropriate conditions. However, like every surgical procedure, it has minor or major complications, and even patients who suffered great distress and suffered serious damage due to infection and bleeding have been reported.
Minor complications:
Bleeding, infection (redness, swelling and discharge), delayed healing, inadequate or irregular circumcision.
Major complications:
Cutting of the head of the penis (Penis amputation), decay of the penis due to infection and circulatory disorder (penile necrosis), injuries of the head of the penis (glans), narrowing of the urinary opening, disproportionate cutting due to curvatures, injuries of the urinary tract (fistula formation).
