Circumcision

Circumcision

Complete Removal of the Foreskin

  • Circumcision is performed as a short-stay procedure under local or general anesthetic
  • The entire foreskin is removed to leave the head of the penis exposed
  • As well as looking different, your penis may feel different at first after the procedure
  • Absorbable stitches are used, which disappear after two to three weeks

What Does This Procedure Involve?

The procedure involves the complete removal of the foreskin. It is performed for one or more of the following reasons:

  • A tight, non-retractile foreskin – known as phimosis
  • Recurrent infections under the foreskin – known as balanitis
  • Skin disease on the foreskin and glans (head of the penis) – such as chronic inflammation (balanitis xerotica obliterans, BXO)
  • Large warty lesions of the foreskin – viral warts, Buschke-Lowenstein tumors
  • Cancerous or pre-cancerous lesions of the foreskin

What are the Alternatives?

Topical creams and washes (including short-term use of steroid cream) – for phimosis, these may decrease inflammation and relieve some tightness, but symptoms often return once the treatment is stopped. They are not suitable, or effective, in all patients and your urologist will be able to advise you accordingly. Circumcision is usually necessary if topical agents fail.

What Happens on the Day of the Procedure?

Your urologist (or a member of their team) will briefly review your history and medications and will discuss the surgery again with you to confirm your consent.

An anesthetist will discuss the options of a general anesthetic or spinal anesthetic. The anesthetist will also discuss pain relief after the procedure with you.

We usually provide you with a pair of TED stockings to wear and give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

Details of the Procedure

  • We usually carry out the procedure under a general anesthetic, but local or spinal anesthetic may be used instead
  • We use local anesthetic nerve blocks, regardless of the type of anesthetic, to provide post-operative pain relief
  • We may give you an injection of antibiotics before the procedure after you have been checked for any allergies
  • We make an incision just below the head of the penis and remove the whole foreskin; this leaves the glans (head of the penis) completely exposed
  • We use dissolvable stitches to attach the skin of your penis to below your glans (see below); these stitches usually disappear within two to three weeks

Are There Any After-Effects?

Cataract surgery involves removing the natural lens and replacing it with an artificial lens. The artificial lens, called an intraocular lens or IOL, works the same way a natural lens works and remains a permanent part of your eye. Some eye problems prohibit the use of an IOL. In these situations, eyeglasses or contact lenses are used to correct vision. During cataract surgery, surgeons use a local anesthetic to numb the area around the eye, but the patient stays awake during the procedure, which normally lasts about an hour or less.

Swelling of the penis which usually lasts a few days

All patients

Increased sensitivity of the head of your penis which can last for up to two weeks

Almost all patients

Permanent altered or reduced sensation in your glans penis (head of the penis)

Almost all patients

Infection of the incision requiring antibiotics or surgical drainage

Between 1 in 50 & 1 in 100 patients (1 to 2%)

Bleeding from the wound, occasionally requiring a further procedure

Between 1 in 50 & 1 in 100 patients (1 to 2%)

Dissatisfaction with the cosmetic result

Between 1 in 50 & 1 in 250 patients

Oedema (swelling) of excess skin requiring further surgery and skin removal

Between 1 in 50 & 1 in 250 patients

Anesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)

Between 1 in 50 & 1 in 250 patients (your anesthetist can estimate your individual risk)

What Is My Risk of a Hospital-Acquired Infection?

Your risk of getting an infection in the hospital is approximately 8 in 100 (8%); this includes getting MRSA or a Clostridium diffcile bowel infection. This figure is higher if you are in a “high-risk” group of patients, such as patients who have had:

  • Long-term drainage tubes (e.g., Catheters)
  • Bladder removal
  • Long hospital stays
  • Multiple hospital admissions

What Can I Expect When I Get Home?

  • You will get some swelling and bruising of the penis which may last several days
  • It can take up to six weeks before the penis returns to its final cosmetic appearance
  • The exposed glans on the penis will feel sensitive for the first two weeks
  • Once the hypersensitivity has settled, your penis will feel a little less sensitive than before the operation
  • The exposed glans may dry out and scab over; applying a little Vaseline will help this and can also help decrease the sensitivity after the operation
  • All your stitches will dissolve, usually within two to three weeks
  • Simple painkillers such as paracetamol are helpful if you have any discomfort
  • Any dressing should fall off within 24 hours; if it does not, or if it becomes soaked with urine, you should remove it
  • Try to keep the area dry for 24 to 48 hours; avoid soaking in a bath
  • You should not swim for one or two weeks
  • Wear loose-fitting clothing for two to three days
  • You will be given a copy of your discharge
  • Any antibiotics or other tablets you may need will be arranged and dispensed from the hospital pharmacy
  • You will continue to get erections as normal after the procedure, but you should refrain from any sexual activity (intercourse or masturbation) for four weeks
  • When you first get erections, you may feel some tightness around the scar tissue; this will regain its normal elasticity within a few months.
  • The procedure will have no effect on your ejaculation and fertility

Multifocal lenses are lenses that provide the patient with distance, intermediate, and/or reading vision. This lens may not be the best option, as some patients are bothered by unusual distance or reading vision. Some other common side effects include impaired vision in bright light and halos around light at night.

General Information About Surgical Procedures

Before your procedure, please tell a member of the medical team if you have:

  • An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft)
  • regular prescription for a blood-thinning agent (warfarin, aspirin, clopidogrel, rivaroxaban, or dabigatran)
  • A present or previous MRSA infection
  • A high risk of variant-CJD (e.g., if you have had a corneal transplant, a neurosurgical dural transplant, or human growth hormone treatment)
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