CIRCUMCISION

PROCEDURE

INDICATIONS:
Definite Indication:
Phymosis
Paraphymosis
History of recurent
Balanoposthitis
Relative Indication:
Recurrent UTI

Contra indication
Hypospadia
Hemofilia
Blood dyscrasia
Local Infection

COMPLICATIONS

Wound infection
Bleeding
Inadequate removal of foreskin
Urinary retention
Necrosis / slough glans
etc

LOCAL PENILE NERVE BLOCK

LOCAL PENILE NERVE BLOCK

Local penile block is based on the anatomic principle of
local field block of dorsal penile nerves. This emerge under
the symphysis pubis in the midline at the penile root and
surface, at about the 10 and 2 oclock positions
dorsolaterally.

Dose :1-3 ml 2% Lidocain without

epinephrin
Penis is prepared and draped
Palpate the inferior border of symphysis
pubis (SP)
Insert needle & directed 0,25-0,5 cm toward
10 oclock position just under SP

 Aspirate the syringe( avoid

intravascular / intracorporeal
injection)
Inject 0,5- 1 ml toward the 10
oclock position
Withdraw the needle and repeat the
procedure at the 2 oclock position.
Inject the remaining anesthetic
subcutaneously at the base of the
penis circumferentially

Make sure that some anesthetic is injected

subcutaneously along the ventral surface of the
scrotum, just at or below the penoscrotal junction

STEPS OF PROCEDURE
Asses the condition of
penis:
Normal
Abnormal:

Hypospadia
curved penis
Inflamation ( balanitis,
balanoposthitis)
etc

SETS ARRANGEMENT

A. Sterile Equipment

Syringe (3mL) 1 pc
Gloves (2 pairs)
Plain and centered hole drapes (2pcs)
Sterile gauze
Antiseptic solution: 10% povidone
iodine
Basin

SETS ARRANGEMENT

Sterile Stainless Steel Container (1 pc)

Hemostat clamps (4pcs)
Anatomical&Surgical Forceps (1 pc)
Needle holder (1 pc)
Scissor (1 pc)
Fine Catgut (5-0,4-0 )

SETS ARRANGEMENT
B.

Non Sterile Equipment

Lidocain HCl/Xylocain injection
Stand lamp
Antibiotic zalf

CIRCUMCISION PROCEDURE

Introduce yourself
Identify the patient : name, age and
medical record.
Informed consent
Preparation of equipment

 SET UP THE EQUIPMENT:

Arrange the lamp

Arrange sterile field
Drop the syringe into the sterile
container with proper technique
Pour antiseptic solution into basin
Prepare anesthetic solution

STEPS OF PROCEDURE
Wash hand thoroughly w/ antiseptic

handsoap
Put on sterile gloves
Genital area is carefully prepared with
povidone Iodine
Place the centered hole surgical drape so
that the penis is in the center of the hole.
Put the plain drape over the thighs.

STEPS OF PROCEDURE
Give local penile block and infiltration
anesthesia
Test the anesthetic effect by pinching
the foreskin with surgical forceps
Retract the foreskin , remove the
smegma with gauze and release all
glanular adhesion with the tip of
hemostat clamp.
Clean the glans once again with
povidone Iodine

Mark the area of foreskin

that would be excised
approximately at the
coronal area by pinching
it with surgical forceps

Apply two clamp at tip

of foreskin (11 oclock
and 13 oclock position)

 The dorsal foreskin is

clamped
(12
oclock
position) with a hemostat
that extends to within 0,5
cm of the coronal sulcus

Another clamp is applied

ventrally, which extends

to the frenulum. This
dorsal (12 oclock) clamp
are then removed.

a longitudinal marked
tissue is then cut with
scissor to the end point
of clamped tissue

The foreskin is cut and removed

circularly leaving 0,5 cm of skin at
the coronal sulcus, taking care to
leave the frenulum completely intact.

Each bleeding vessel is

then clamped and ligated
with fine catgut.

Complete excision of the forensk

 The skin edges are

approximated with
interrupted fine catgut
suture.
Cleansed the dirt
(blood/pov.Iodine by
gause wetted by Na CL
physiology

Apply antibiotic

/antiseptic zalf at the

sutured area and leave
it without dressing

 Gather

and
discard
equipment. Clean non
equipment

disposable
disposable

Wash your hand thoroughly with

antiseptic hand soap

Evaluation And Documentation

Evaluate the following criteria:

Observe the possibility of bleeding
Document the following :
Date and time of circumcision procedure

Name of physician