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CIRCUMCISION

What is circumcision?

Male circumcision is the surgical removal of the fold of the skin covering the glans penis. A very ancient tradition, circumcision is a routine procedure in neonatal infants. It is a fairly complex procedure and usually done for the well-being of the child. It is also performed in adults. The penile skin is smooth and hairless, covers the glans and continuous with the lower abdominal wall. It is folded to form a prepuce at the corona, overlying the glans. Recreation of a circumcised penis is not possible. Circumcision does not affect fertility.

Male Circumcision Treatment Kochi

  • Health benefits
    • Hygiene
    • Reduced risk of human papillomavirus and penile cancer
  • Physical conditions that invite circumcision
    • Phimosis:
      • Condition of the distal prepuce not being able to retract over the glans penis
      • Progressive keratinization of epithelial layers between glans and inner prepuce
      • Individual is at a risk of developing chronic Infections and skin irritations
      • Severe phimosis :
        • Bulge in the foreskin during micturition
      • Acquired phimosis:
        • Occurs due to unhygienic conditions
        • Chronic balanitis
        • Forceful retraction of foreskin
    • RParaphimosis
      • Inability to bring back retracted foreskin to its natural position
      • It is a urologic emergency
      • Risk of venous engorgement, edema of glans, arterial occlusion and loss of glans if not treated immediately
      • Pain and swelling up of the retracted foreskin
      • Elective circumcision is performed
    • Balanitis or posthitis:
      • Infection of glans penis is balanitis; infection of prepuce is posthitis
      • Signs of erythema, swelling, tenderness and warmth are seen
      • Seropurulent exudate is evident with a foul smell
  • Procedure and Treatment
    • steps of the surgical procedure for neonatal circumcision:
      • Dilation of preputial orifice is done to evaluate the glans penis
      • An estimate of the amount of foreskin to be removed is taken
      • Inner preputial epithelium is separated from the glans
      • Hemostasis is achieved with the placement of a device
    • Instruments used:
      • For infants < 5 kg:
      • Mogen clamp
      • Gomco clamp
    • For children up to 10 kg:
      • Plastibell device under local anesthesia – anesthetic is injected into the base of the penis
      • Suture compression of foreskin over a plastic ring to protect the glans – this induces necrosis
      • Foreskin is removed
      • Hemostasis is achieved adequately
      • Penis is covered in an ointment and wrapped with a gauze
      • Skin sloughs off in 5 to 7 days
    • For adults :
      • Assessment of amount of prepuce to be removed
      • Dorsal slit followed by circumferential excision of mucosal layer and skin
      • Approximation and hemostasis using sutures
    • At Jacob’s hospital , Kochi a stringent post-surgical regimen is prepared for the patient:
      • Patients will be given a bath within 24 hours of the surgery
      • Triple-ointment application should be done after each diaper change – 4 to 6 times a day
      • Follow-up visit is recommended within 1 week
      • Both pharmacologic and non-pharmacologic interventions are recommended to reduce pain

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