Blake Veglia

Male Circumcision

OB Clinical Paper

Male circumcision is one of the most controversial subjects in the surgical

practice and has been since the beginning of time. There are many different

implications why someone would choose to circumcise their son. Some of these

ideologies include religious purposes, hygiene and sometimes just for cosmetic

purposes. Although it is very controversial there are clear surgical indicators for this

procedure. The American Academy of Pediatrics recommends newborn male

circumcision for its preventive and public health benefits that has vastly outweighed the

risks of newborn male circumcision. Now the controversy doesn’t just end there, we

take it a step further. There is not just one clear and concise way to circumcise a child

and some seem to be more inhumane than others.

Although they seem painful and inhuman a lot of them are done under

local anesthesia. There are many ways of achieving this: penile ring block, penile dorsal

nerve block, and local anesthetic spray. But, that’s the easy part. The hard part comes

in when we are depicting which method should be used. The first type that we are going

to explore is the shield and clamp method. In this method, the prepuce is pulled out

distal to the glans and a metal shield is slid over the prepuce immediately distal to the

glans. A scalpel is used to remove the redundant prepuce distal to the shield. The shield

protects the glans and the frenulum is not involved in the excision. The inner layer may

then be slit back behind the glans and excised, this ensure full exposure of the glans
after healing. No stitching is done, the wound simply being bandaged to achieve

hemostasis. The major concern for this method is bleeding and should be monitored

closely.

Another common method used would be the plastibell method, which is where a

bell with a groove on its back is slipped between the glans and the prepuce. The

prepuce is pulled slightly forward and suture material is looped around in the groove

and tied tightly. The suture cuts off the blood supply to the prepuce distal to the groove,

which withers and drops off in 7-10 days. Glans necrosis and failure of the prepuce to

fall-off are the two main complications of this technique. Inappropriate bell size and not

tight enough suture over the prepuce are the main cause of these complications. Its

main advantage is low risk of bleeding.

The last topic we are going to discuss is the Gomco clamp technique, which is

the technique that I was able to view in clinical. A special instrument called a probe is

used to separate the foreskin from the head of the penis. Next a bell-shaped device is

fitted over the head of the penis and under the foreskin. The foreskin is then pulled up

and over the bell and a clamp is tightened around it to reduce blood flow to the area. A

scalpel is used to cut and remove the foreskin. It was a very interesting and intricate

procedure to witness but also seems to be very painful.

No matter what technique is used, after a circumcision, doctors apply petroleum

ointment over the wound and wrap the baby's penis in gauze to keep the wound from

sticking to his diaper. The only time they don’t add petroleum is during the Plastibell

technique. There is very little bleeding after circumcision, no matter which technique is
used. Though you may see a little bit of blood oozing from the edge of the incision or on

the diaper when you first take the dressing off, this will generally stop on its own. The

main thing we watch in each method is bleeding and signs of infection.

So although it is somewhat uncomfortable for the bay the benefits further down

the road greatly outweigh the cons. There have been multiple studies that show that

infants with circumcision are less likely to get a urinary tract infection. Also, not only

does it help infants it may also lower a mans risk for developing cancer of the penis, and

decrease their risk of contracting HIV and other sexually transmitted diseases.
 References:

Blank S, Brady M, Buerk E, Carlo W, Diekema D, Freedman A, et al. American Academy of

Pediatrics, Task force on Circumcision: Male circumcision. Pediatrics. 2012;130:e756–85.

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Fazel-Rezai R, editor. Biomedical Engineering: From Theory to Applications. Rijeka, Croatia:
InTech; 2011. pp. 315–54.

Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with
those for uncircumcised boys. Pediatrics. 1989;83:1011–5.

Wiswell TE, Hachey WE. Urinary tract infections and the circumcision state: An update. Clin
Pediatr (Phila) 1993;32:130–4.

Wiswell TE. Neonatal circumcision: A current appraisal. Focus Opin Pediatr. 1995;1:93–9.