Newborn Circumcision

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Parental desire
CONTRAINDICATIONS

Absolute

  • Hypospadias, epispadias, or megaurethra
  • Unusual appearing genitalia
  • Inability to determine the phenotype of the child (ambiguous genitalia)

Relative

  • Age younger than 12 hours
  • Age greater than 6 to 8 weeks
  • Severe illness
  • Prematurity (until the child is ready for discharge from the hospital)
EQUIPMENT
  • Assistant for holding infant, infant restraint board and leg straps, or circumcision chair
  • Anesthetic supplies
  • Sterile gloves
  • Antiseptic solution or swab sticks
  • Sterile drape with 1-inch fenestration
  • Sterile 2 × 2 or 4 × 4 gauze pads
  • Three straight mosquito hemostats
  • White petrolatum ointment
  • Disposable diaper
  • Glucose water and/or sugar-coated pacifier (optional)
  • Skin marking pen (optional)
  • Flexible blunt probe (optional)

Equipment for Mogen Technique

  • Mogen clamp, neonatal size (2.5-mm slot)
  • No. 10 blade scalpel

Equipment for Gomco Technique

  • Straight scissors with one blunt tip
  • Gomco circumcision clamps (1.1-, 1.3-, and 1.45-cm sizes)
  • No. 10 blade scalpel
  • Sterile safety pin (optional)

Equipment for Plastibell Technique

  • Straight scissors with one blunt tip
  • Plastibell device (1.1-, 1.2-, 1.3-, and 1.4-cm sizes)
  • Iris scissors

Equipment for Bleeding Complications of All Three Techniques

  • Topical epinephrine
  • Topical hemostatic agent of choice
  • 5-0 absorbable suture (chromic or catgut) on a taper point needle
  • Needle holder and suture scissors
ANATOMY
  • Neonatal foreskin
    • Composed of three layers—skin, loose subcutaneous tissue, and mucosa
    • A band of tissue called the frenulum attaches the foreskin to the ventral side of the urethral meatus. The frenulum contains a small artery.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Instruct the parents to watch for meatal stenosis.
  • Administer an oral dose of acetaminophen (10-15 mg/kg) (optional).
  • Do not discharge the infant for about an hour after the procedure. Ensure that the infant has urinated before the time of discharge.
  • Parents should report any bleeding or signs of infection.
  • The patient education handout includes post-procedure instructions for parents.
  • Instruct parents to apply a smear of white petrolatum to the front of the diaper for the first week.

Mogen and Gomco Techniques

  • Advise the parents to retract the penile shaft skin back from the corona and to apply white petrolatum to the area at each diaper change. Wound care should continue for a week to prevent adhesions from forming.
  • Parents can wash the penis with soap and water starting the day after surgery.

Plastibell Technique

  • Advise parents of what to expect with a Plastibell.
  • Parents should be advised to begin wound care with each diaper change after the Plastibell falls off. For wound care, they should retract the infant's penile shaft skin back from the corona and apply white petrolatum to the area.
COMPLICATIONS
  • Bleeding
  • Infection
  • Trauma to the glans or urethra
  • Poor cosmetic result
  • Paraphimosis from inadequate opening of the Mogen crush line after the procedure is completed or from the use of a Plastibell that is too large.
  • Degloving of penile shaft skin
    • A rare complication of using a Gomco clamp that is too large or of pulling too much foreskin through the base plate hole
  • Meatal stenosis: Rare, but a possible late complication
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