Circumcision Report Report

Circumcision is the removal of the foreskin from the glans of the penis. This procedure is performed for a variety of religious, cultural, or medical reasons. Often, the parents of the baby are concerned about the benefits of a circumcision, how it is performed, the roles of the medical team during the procedure, and if it is painful for the baby. This paper will discuss these topics.
One of the most common questions that parents will have is the benefits versus adverse effects of having a circumcision. While many people elect to have a circumcision for religious or cultural reasons, there are also medical benefits to having a circumcision. Due to the nature of the penile foreskin, it can create an environment that harbors microbes, leading to a urinary tract infection (UTI). Removing the foreskin will lower the incidence of male UTIs. There has also been evidence that a circumcision can decrease the risk of STD transmissions and penile cancer. Lastly, circumcision will prevent any foreskin retraction disorders, such as phimosis. However, there are adverse effects of circumcisions. Patients state that there is decreased sensation to the glans after the procedure. There is also a risk of complications, such as bleeding, adhesions, and lacerations. It is up to the parents of the child to weigh the risks and benefits of having a circumcision and decide whether to have the procedure performed.
There are three primary techniques used to perform a circumcision, the Gomco clamp, the Mogen clamp, or the Plastibell device. There is no advantage to one procedure over the other two. It is up to physician preference to decide on the preferred approach. During the Gomco clamp technique, forceps separate the foreskin from the glans. Then an incision is made into the dorsal foreskin. The Gomco clamp has a bell attachment that protects the glans. The penis and bell are inserted into the clamp, where only the foreskin will be exposed. The physician will then use a scalpel to remove the foreskin. The circumcised penis will then be monitored for bleeding and wrapped with a non-occlusive dressing. During the Mogen approach, the foreskin is separated in a similar fashion as the Gomco. Once, the foreskin is free; the physician will pinch the foreskin and suppress the glans of the penis. The Mogen clamp is then attached so only the foreskin is trapped in the clamp. After ensuring that the glans is inferior to the clamp, the physician will use a scalpel to remove the foreskin. After checking for hemostasis, the penis is wrapped with a non-occlusive dressing. The Plastibell procedure is similar to the Gomco and Mogen regarding the separation and a dorsal foreskin incision. Once the foreskin is separated, then the Plastibell device, is attached to the glans of the penis. This device consists of a ring of plastic and string. Once the Plastibell is secured, then the foreskin is pulled over the ring, and the line is tied to the ring with the foreskin above the device. The physician will cut the foreskin, removing it from the apparatus. The Plastibell is then kept on the glans for about a week, so the excess foreskin can undergo necrosis and fall off. The device should fall off the glans of the penis at that time.
During a circumcision, the role of the nurse is to help the physician with the procedure. Their first role is to check the consent form and the baby’s wristband. After identifying the patient, the nurse would help secure the child to the board to restrain their arms and legs. The nurse will also draw the required anesthesia. Once the procedure begins, the nurse can comfort the patient by administering sugar via pacifier. After the procedure is over, the nurse’s role includes transporting the patient pack to their mother.
Pain management is important in making a circumcision procedure as safe as possible. There are two ways to control pain before circumcision. The first method is a lidocaine cream to numb the penile area before the procedure begins. The average onset of activation is up to an hour. The second method to supply anesthesia is to inject lidocaine around the dorsal penile nerve. This medication will numb the penis and the glans. Another method to ensure proper anesthesia is to use a ring blockade on the penis. The proceduralist would administer some lidocaine on the lateral side of the penis. Then, they would re-insert the needle and anesthetize around the penis. If the patient is experiencing pain post-procedure, acetaminophen, and topical creams can be used acutely. If the pain is recurrent, then the patient would need to be referred to a urologist.
A circumcision does have its advantages and disadvantages to the procedure. It is up to the parents of the patient to enquire about outcomes of the circumcision, what technique is the physician going to use, and the use of pain medication for the procedure. By finding out this information, the parents of the patient will ensure the best outcome for their child.