Difference between circumcision and phimosis

Circumcision is also known as circumcision

[Indications]

1. Children with circumcision who are prevented from urinating or have recurrent infections due to narrowing of the opening of the foreskin sac.

2. Adults with prepuce or with recurrent infections due to phimosis.

Circumcision is normal in childhood, and circumcision should not be performed in infants with phimosis or in children with phimosis if there are no complications. Because the foreskin of children under 3 years old mostly disappears on its own with age; another part of the children as long as the foreskin is repeatedly retracted upward, expanding the opening of the foreskin sac, will reveal the head of the penis, and there is no need for surgical excision.

[Pre-operative preparation]

1. The night before and the day of surgery, the patient is instructed to wash the local area.

2. Complicated foreskin, penile head inflammation, need to choose drugs and local immersion treatment, inflammation subsides before surgery.

[Anesthesia]

(1) subcutaneous penile root and both sides of the penis spongiosum anesthesia (2) urethral spongiosum anesthesia

Figure 1 Penile spongiosum anesthesia

Local anesthesia or penile spongiosum anesthesia; pediatrics can add basic anesthesia [Figure 1 (1) ⑵].

[Surgical steps]

1. Position The horizontal position.

2. Cleaning and disinfection Wash the local area with soapy water and saline, and disinfect it with 1:1000 Neosporin solution; for circumcision, use a syringe to connect the venotomy needle to inject Neosporin solution into the prepuce sac to disinfect it.

1) Clamp up the dorsal foreskin with hemostatic forceps; 2) use a slotted probe to peel off the foreskin adhesion

3. Separation of adhesion For those who have narrowed circumcision and adhesion between the foreskin and the head of the penis, expand the opening of the foreskin with a hemostatic forceps, and then clamp up the dorsal edge of the median part with two hemostatic forceps (with the distance of the two forceps at a distance of 0.2 cm) [Fig. 2 (1)]. A slotted probe was used to separate the adhesions until the head of the penis was completely separated from the foreskin [Figure 2 (2)]. The foreskin sac and the head of the penis were then cleaned with sterilized saline.

4. Designing the incision A hemostat is clamped at the prepuce tie to lift the foreskin. The tip of the knife is used to make a cut in the outer plate of the foreskin at a distance of 0.5cm from the distal edge of the coronal sulcus, ready to be used as a circumcision incision, to prevent excessive excision.

5. Dorsal incision The inner and outer foreskin plates are cut with scissors along the groove of the proboscis, and the inner plate of the foreskin should also be cut to about 0.5 cm from the margin of the coronal sulcus [Figure 2 (3)].

3) Cut the foreskin along the proboscis groove ⑷Circumcise the foreskin 0.5 cm from the coronal sulcus

6. Excision of the foreskin Align the inner and outer plates of the foreskin, pull the hemostat clamps clamped to the dorsal side of the foreskin and the tethered ligaments outward, and then double-check that the incision mark on the outer plate of the foreskin is appropriate as a circumcision incision. If appropriate, use curved scissors to cut the right skin flap along the incision approximately 0.5 cm from the coronal sulcus [Fig. 2 (4)] and then cut the left side. The inner and outer plates at the prepuce tie may be left uncut or retained more [Figure 2 (5)].

7. Hemostasis The penile skin is retracted upward to reveal the bleeding point and then the bleeding is stopped, and special attention should be paid to ligating the superficial dorsal penile vein just medial to the dorsal side of the penis [Fig. 2 (6)].

(5) The foreskin should be retained more at the tethered band (6) Ligation of the superficial dorsal penile vein to stop bleeding

8. Suture Use a fine silk thread to first close one suture at each of the dorsal, ventral, left, and right of the circumferential incision, and don't tie the suture too tightly so as to avoid strangling the skin when the tissues are edematous. The sutures are not cut short and are left for fixing the dressing. Then use 1 to 2 sutures between each two sutures, which should be threaded close to the cutting edge [Figure 2 (7)].

(7) Suture the inner and outer panels (8) Secure the Vaseline gauze with sutures

Figure 2 Circumcision

9. Dressing A piece of Vaseline gauze (with the burlap folded over the inside) is wrapped around the circumcision site, secured with sutures that are left in place, and then wrapped with several layers of gauze [Fig. 2 (8)].

[Intraoperative precautions]

1. During circumcision, the severed ends of the blood vessels between the inner and outer plates tend to recede proximally and must be identified and ligated; otherwise, a large hematoma can form.

2. The foreskin should not be cut too much to avoid causing painful penile erection. Generally the inner plate of the foreskin should be cut to about 0.5cm from the coronal groove. The tethered part should also not be left too little.

[Postoperative treatment]

1. Take sedatives at bedtime for 3 to 4 days after surgery to prevent penile erection, which can cause pain and bleeding.

2. Tell the patient not to wet the gauze when urinating.

Post-circumcision edema

Oedema in the short term after circumcision may be due to the following reasons:

1. It is that the surgery cut off some of the superficial venous blood vessels, resulting in poor venous return. Postoperative dressing bandage is too tight, resulting in poor local reflux.

2. It is that the foreskin itself has a narrow ring, the narrow place is not completely cut, after the operation because the narrow ring still exists, resulting in poor venous return.

In general, poor lymphatic return can lead to lymphoma, and poor venous return can lead to edema of the foreskin.