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One of the people who need to be circumcised is:

1. The circumcised children who are prevented from urinating or have repeated infections due to the narrow opening of

One of the people who need to be circumcised is:

1. The circumcised children who are prevented from urinating or have repeated infections due to the narrow opening of the foreskin sac.

2. Adults who are circumcised or suffer from recurrent infections of the prepuce.

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.

The procedure:

[Pre-operative preparation]

1. The night before and the day of the operation, 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]

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

[Surgical steps]

1. Position The horizontal position.

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

3. Separation of adhesions If there is narrowing of the circumcision and adhesion between the foreskin and the head of the penis, first expand the opening of the foreskin with a hemostat, and then clamp up the dorsal edge of the median part of the dorsal edge with two hemostats (the two clamps are separated by 0.2 cm) [Figure 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)].

6. Excision of the foreskin Align the inner and outer foreskin plates, pull the hemostat clamped to the dorsal side of the foreskin and the tethered ligament outward, and then review the appropriateness of the outer foreskin plate incision as a circumferential 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 dorsal to the penis [Fig. 2 (6)].

8. Suture With a fine silk thread, first in the circular incision of the dorsal, abdominal, left, right, each one suture, ligature should not be too tight, so as not to avoid tissue edema when strangulation of the skin. 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)].

9. Dressing A strip of petroleum jelly gauze (with the burlap folded inside) is placed around the circumcision, secured with sutures left long, 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. Advise the patient not to wet the gauze when urinating.

Figure 1 Penile cavernous anesthesia

(1) Subcutaneous anesthesia at the root of the penis and cavernous anesthesia on both sides of the penis

(2) Urethral cavernous anesthesia

Figure 2 Circumcision

(1) Clamping up the dorsal foreskin with hemostat

(2) Peeling off the prepuce adhesion with the slotted probe

(3) Cutting open the prepuce along the groove of the probe

(4) 0.5cm from the coronary groove ring cut foreskin

(5) tie at the foreskin should be retained more

(6) ligation of the dorsal superficial vein of the penis to stop bleeding

(7) suture inner and outer plate

(8) with sutures fixed Vaseline gauze

Three, the doctor who does the surgery can be either a man or a woman. But the ones who do the support work are usually young female nurses.