Urology

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Circumcision

What does this procedure entail?

It is the surgical removal of the foreskin (complete or partial) and is usually performed in case of narrowing and problems with pulling the foreskin over the glans.

The surgery is performed under general anaesthesia with short-term hospitalisation. If your medical condition does not allow general anaesthesia, the procedure may also be performed with local anaesthesia during short-term hospitalisation.

If the patient has a short frenulum, its plastic surgery (frenuloplasty) is usually performed simultaneously.

What are the alternatives to this procedure?

Drugs and ointments with an anti-inflammatory effect to soften/loosen the annular narrowing of the foreskin

Easy cutting and loosening of the narrowing ring of the foreskin

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations before the procedure under general anaesthesia to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery. You will be asked not to eat or drink for at least 6 hours before the surgery! In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

artificial heart valve
coronary artery stent
pacemaker
artificial joint
artificial vascular graft
neurosurgical bypass
other implanted foreign body
use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
drug and other allergies
any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

Before the surgery, it is advisable to shave the area around the root of the penis

What will happen during the surgery?

The procedure is usually performed under general or rarely local anaesthesia. A numbing substance is administered to the subcutaneous tissue of the penis root during local anaesthesia (it is necessary to exclude allergy to these substances in advance!)

The complete foreskin is removed (after the procedure the entire glans remains exposed), or only a partial removal is performed so that it can be pulled over the glans during erection (must be discussed in advance with the surgeon!). The wound after the removed foreskin is sutured with absorbable sutures that do not need to be removed.

The procedure takes approximately 30 minutes.

What will happen immediately after the procedure?

You may feel discomfort or even mild pain for several days after the procedure – you can use common painkillers. An ointment is applied to the wound to prevent it from sticking to the underwear – it is recommended to wear loose underwear for 2-3 days. Urination itself should not be affected by the surgery. Starting day 2 after the surgery, baths in a lukewarm chamomile or rapeseed extract solution are recommended, with ointment application after drying (you will receive the prescription upon hospital discharge).

After the procedure is completed or when you are fully conscious, you should:

ask if the planned outcome was achieved
inform the medical staff about any problems
ask what you can and cannot do
ask all the questions you have for the healthcare professionals and members of the medical team.
remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

Swelling of the penis lasting several days

Occasional (2-10% of procedures of this type)

Incision site infections requiring additional surgical or antibiotic treatment.
Wound bleeding, requiring possible surgical revision
Permanently altered or limited sensitivity of the glans of the penis
Retention of absorbable sutures after 3-4 weeks requiring their removal

Rare (may occur in 2% of procedures of this type)

Scarring
Incomplete satisfaction with the cosmetic effect
Possible need to remove excess skin at a later time
Consent to tissue sample collection (biopsy) from an abnormal area on the glans of the penis if cancer is suspected

Hospital infections

MRSA colonisation (0.9% – 1 of 110)
Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

Get recommendations on recovery at home
Ask when you can return to normal activities such as work, exercise, driving, housework and sexual activities
Get a contact number for further questions after returning home or in case of trouble
Ask about the date and place of subsequent check-ups (hospital or your doctor)
Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs

Upon your departure from the hospital (sometimes several days later), you will receive a hospitalisation report / report on the procedure. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

It will take at least 10 days until healing is noticeable – you can return to work if you feel well (it also depends on the nature of your work). You should avoid sexual intercourse for at least 4 weeks.

What else should I watch out for?

You will notice some swelling of the penis for a few days – after 3-4 days it will subside. This is normal and you don’t need to worry about it. If you experience fever, redness, pulsation or secretion from the puncture site around the catheter, or bleeding, see your doctor/urologist.