What is circumcision?
At the tip of the penis, the skin fold that closes the urine exit hole and creates a closed space in that area is called the prepisium (foreskin). Circumcision is the process of cutting the foreskin to a suitable length all around, exposing the glans (penis head), and suturing the skin with the remaining mucosa.
In addition to being a surgical procedure, circumcision is a social phenomenon with different rituals in every religious or cultural community.
Why is circumcision done?
It is the most commonly performed surgical procedure in the world. It has a history of 10,000 years. We see drawings mentioning circumcision in Hittites, ancient Egypt, Hebrews and Aztecs. It is understood that even in primitive times, its medical benefits could not be fully explained, but the practical benefits of circumcision were noticed and widespread. It is mostly applied for sociocultural, religious and rarely medical reasons.
Frequent urinary tract infections, phimosis (too narrow foreskin tip), recurrent attacks of balanitis (inflammation of the foreskin), regionally for protection against AIDS can be counted among the medical causes. Circumcision is a surgical procedure regardless of who performs it, and physical examination and tests must be done beforehand.
When should I do the circumcision?
It is one of the most frequently asked questions to us. There is no absolute truth about this. However, we have an answer to the question of when we should not have more done. We do not recommend this period of time, especially between the ages of 2-5, where sexual identity begins to be recognized and the fear of castration, which we call the phallic period, is experienced. In my newborn period (first 1 month) or after the age of 5, if the patient is prepared enough, it can be done with local anesthesia if he/she wants it. We recommend that all circumcisions be performed under superficial anesthesia.
Who should perform circumcision and in what method?
It is the oldest and the most performed surgical procedure in the world. We call it a surgical procedure because if it’s not done in the right hands and in the right way, it can cause problems. Pediatric surgeons, pediatric urologists, urologists or general surgeons trained for this procedure perform this procedure.
There are two types of surgical techniques as performed technique. One of them is the method of blowing, pinching the excess skin just above the tip of the pipi with the help of a clamp and cutting it with a scalpel or cautery. However, our most preferred technique is the open (dorsal slit) technique. It is the cutting of the prepisium by first opening it vertically with scissors, seeing the mucous part you will leave, and adjusting it to the desired width. It is the best technique in terms of both less complications and aesthetics.
How long is the recovery process?
Most of the time, even dressing is not required after the procedure. It may be necessary to use pain relievers and antibiotic creams for the first two days. Slight swelling at the tip of the penis is expected and returns to its normal appearance within 2 weeks. A warm sitz bath, started 3 days after the circumcision, is very beneficial for the swelling and melting of the stitches.
Are there any complications of circumcision?
Although the complication rate of circumcision is low (1-7%), some complications can cause lifelong distress in the child. There are 21 complications described so far. Some of the most common complications are;
- Bleeding
- narrowing of the urethra
- Having your penis buried and pretending to be uncircumcised
- Injury of the urinary tract
- Such as cutting part or all of the head of the penis during the procedure.
How is the care after circumcision?
We do not hospitalize you after the circumcision procedure. In our application; A few hours after the procedure, the baby/child goes home after urinating and feeding. We do not want him to survive that day in terms of payment. We generally do not apply dressings, we only want the antibiotic cream to be applied 2-3 times a day on the penis for two days. Even under general anesthesia, they do not feel pain for about 6-8 hours since we use local pain relievers during the procedure. Afterwards, we recommend continuing with pain relief syrups for a day or two at home. Especially in adherent pipi, there is an increase in yellow secretion on and around the pips after circumcision, and families may perceive this as inflammation. In particular, we tell families that this is not a problem, that this is a normal thing. We recommend warm sitz baths three days after circumcision, in order to increase the healing of the penis and to dissolve the stitches we have thrown during the procedure. Warm sitz baths should be in the form of sitting in warm water 3-4 times a day for 10-15 minutes. We recommend doing about 5-7 days.
What is the difference between prophetic circumcision (hypospadias) and normal circumcision?
Sunnah of the Prophet is a disease, and it is characterized by the circumcision of the foreskin 360 degrees and the absence of the urethra at the tip of the glans penis. It requires special surgery. It varies from light form to heavy form. The circumcision tissue, which exists especially in its heavy forms, is used to get the pipi hole up. Therefore, patients with hypospadia should never be circumcised.
Who is not circumcised?
Since the foreskin can be used during the surgery in children with the circumcision of the Prophet, circumcision should not be performed beforehand.
Circumcision should not be performed in patients with hemophilia and other blood coagulation disorders and those who are prone to bleeding, without taking the necessary tests and precautions. If there is penile impaction due to the weight of the baby or child, circumcision may be delayed.
Prof Dr Halil TUĞTEPE / Pediatric Urology Specialist
