What is circumcision?
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.
What is the foreskin there for?
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other.
What are some reasons that circumcision is performed?
1. Hygiene - It is often said that a circumcised penis is cleaner, or easier to keep clean. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.
2. Infections - Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners; reduced risk of sexually transmitted disease (STD).
3. Religion – Many cultures and religions normalise circumcision for various reasons.
What is Phimosis?
Inability to retract preputial skin is called phimosis. It is different from inability to retract preputial skin in children, which is normal.
What are the symptoms of phimosis?
Ballooning of the penis when passing urine. Inability to pull back preputial skin. Only partially retracting preputial skin. History of paraphimosis.
What happens if I don’t take treatment?
Paraphimosis is a condition in which the skin retracts back but does not come forward. It generally happens during erection. The danger is that if the retracted skin does not come forward then it may cause pressure on the shaft of penis and stop blood supply. As a result, swelling and pain can happen at the tip of the penis and there can be permanent damage to the penile tissues.
What are some non-surgical treatment options?
Various ointments are available which contain steroids and anaesthetic agents. They help in reducing any inflammation which may be present because of infection. Anaesthetic agents provide lubrication and also decrease pain sensation.
Also one can use dilators of the penile skin.
Some exercises can also be done to expand penile skin.
All these methods provide limited and temporary relief hence cannot be called definitive treatment for phimosis
What are various surgical options for treatment?
There are many surgical treatment options available:
1. Laser circumcision.
In laser circumcision, a laser device is used to cut the skin. The advantages are early recovery and minimal blood loss. The cuts on the skin are more accurate than conventional methods of doing circumcision. Sutures dissolve automatically within a few days. The dressing required is minimum. Number of follow-up required is minimum. This is by far the most modern method of treatment available for circumcision.
There are no obvious side effects of the procedure. However, on has t accept that like any other surgery, circumcision also involves complications related to the procedure.
2. Aanstomat or Stapler circumcision
In anstomat or stapler circumcision, an anstomat or stapler device is used to perform the surgery. Most commonly second generation ZSR device is used for the procedure. An anstomat or stapler circumcision device is applied over the penis to remove the foreskin.
After the procedure you are left with a ring of small metal clips which fall of automatically within few days. While the rings are there they may cause some irritation or pain which is easily covered by painkiller and anti-inflammatory medication.
A third generation device which uses a silicone ring is also available, here instead of metal clips, silicone rings are utilised for holding the cut layers of the skin together. After few days, the silicone ring falls off automatically.
3. Conventional surgery
In conventional surgery a surgical knife or blade is used as the cutting tool to perform the procedure. The chances of bleeding are relatively higher and the cosmesis is relatively inferior to other methods of surgery.
It is only reserved for cases in which other methods cannot be utilised.
The recovery time is relatively longer and more care needs to be taken of the wound till it heals completely.
4. Silicone ring
This is one of the newer methods of circumcision. However, it is not as popular as other methods. The main reason is that the time taken for the silicone ring to fall off many days and it becomes cumbersome to take care of the wound during that time.
5. Other uncommon methods like clamps, guillotine method etc.
What are the risk and complications of surgery?
Like any other surgery circumcision also comes with its own bag of risks and complications. However, minor the chances may be, it is important for you to be aware of them and understand them before committing for the procedure.
Bleeding – some minimal amount of bleeding is expected. It is generally easily controlled during the procedure itself. The amount of bleeding can vary from person to person and procedure type. Conventional surgery is known to allow most amount of bleeding and laser and ZSR circumcision methods have less or no bleeding at all.
Infection – this is of utmost importance after the surgery is over. At home care is necessary to maintain hygiene and safety.
Is the surgery painful?
It has more of discomfort than pain. However, nothing severe or unbearable. After the surgery you will be given sufficient painkiller and anti-inflammatory medication to cover any upcoming pain and swelling.
What type of anaesthesia is used?
The procedure is generally done under local anaesthesia. It is the safest and the most appropriate form of anaesthesia for this particular procedure. However, an expert opinion from an experienced anaesthetist is always taken to decide the best method of anaesthesia for you.
Will I require hospital admission?
It is generally done as a day procedure At least a hospital stay of 5-6 hours is advised. Stay may increase if you have associated co morbidities which may require extensive anaesthesia or extra investigations. However, we can safely say that the admission time rarely exceeds 24 hrs.
What investigations do I need to do before surgery?
Routine blood investigations are done to ensure safe planning of your procedure. All specific instructions regarding investigations and pro op preparations will be explained to you prior to the procedure.
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