The foreskin can be removed for religious reasons or for problems such as a tight foreskin (phimosis), recurrent urinary tract infections, recurrent foreskin infections (balanitis), problems with intercourse i.e tight painful foreskin and to reduce the risk of possible penile cancer in the future although the risk of penile cancer in uncircumcised men is rare.

Foreskin removal can be performed user local anaesthetic or general anaesthetic depending on the age of the child or man.

Religious circumcision is usually performed under local anaesthetic and is best performed as soon after birth as possible. This can be performed with local anaesthetic creams (EMLA) or AMETOP or with the addition of an injectable local anaesthetic (dorsal penile nerve block). There are advantages and disadvantages to both and Professor Raza will be happy to discuss these with you before deciding on the best approach.

The technique is usually a plastibell technique using a small plastic bell shaped ring to protect the head of the penis (glans) while the foreskin is removed. The ring usually falls off itself after 5-10 days without any pain to the baby.

Image of plastibells

Plastibell rings

Platibell Rings

Procedural steps

Pre procedure 

  1. You will bring your son to the clinic a minimum of 30 minutes before the procedure. You should feed your child milk before leaving home so he is not hungry when he arrives at the clinic.
  2. Please ensure you bring your Red Book with you to the clinic. Also bring 3-4 nappies as these will need to be changed.
  3. You will fill out a medical questionaire and a consent form for the procedure.
  4. Both parents should be present and sign the consent form in the clinic.
  5. Your son will then be inspected – on a rare occasion the procedure may not go ahead as Professor Raza may note an abnormality of the penis which makes it unsafe to do a circumcision. He would then ask you to see your GP so your son can be referred to a Paediatric Urologist for further assesment.

Procedure

  1. If the procedure is safe to go ahead a local anaesthetic cream will ne applied to the penis and this will be given time to take its effect.
  2. A local anaesthetic injection is often used to provide further pain control just prior to the procedure.

Immediate post procedure

  1. Once the procedure is performed Professor Raza will inspect the penis at least 2 times before you go home.
  2. You will be allowed to give your son milk just after the procedure.

At home after procedure

  1. On the day after the circumcision you can bathe your son in a tub but do not rub the penis or the ring.
  2. There will be some swelling of the penis whilst the ring is on and for a short period after the ring has fallen off.
  3. The bleeding usually stops quickly after the procedure but you may see some spotting of blood on the nappy for the next several days. This is normal.
  4. In the first 24 hours after the circumcision you should inspect the nappy at least every 1 hr.
  5. The child will pass urine (wee) as normal.

Emergency situation (rare)

  1. If the bleeding is excessive or continuous call Professor Raza immediately for advice. Risk of bleeding up to 2-4% ( literature data)
  2. Antibiotics are not necessary during or routinely after the procedure as the risk of infection is small. If you are concerned there might be an infection contact Professor Raza team. He may advise for you to see the GP initially in that situation to be prescribed antibiotics if necessary. ( risk of infection 1 % – literature data)

Other commoner complications

Too little removal of foreskin

Too much removal of foreskin

Early / late separation of ring

Boy or adult circumcision

This is either performed under local or general anaesthetic. A routine circumcision surgical technique is used. 

This is usually performed in a theatre setting. The procedure takes approximately 40-60 minutes.

Dissolvable stitches are used and these usually disappear within 7-10 days.

You are normally discharged home the same day.