Approaches of circumcision and analysis
New generation laser circumcision
New generation laser circumcision is a new way of circumcision surgery researched and developed by our specialists. Thousands of patient had this new generation of laser circumcision and proved it to be safe and of good clinical outcomes.
New generation laser circumcision is performed with a carbon dioxide laser for cutting of the foreskin and at the same time, it cauterizes the cut edge. The cut wound is closed by surgical absorbable sutures and then further covered and strengthened with the new sterile medical super-glue.
After the laser cut and burn, the wound edge burnt tissue coagulates and forms a coagulum covering the free nerve endings of the wound edges. There will be less stimuli reaching the free nerve endings to sense and in turn less post operative wound pain comparing with traditional circumcision using scalpel or scissor to cut the wound.
Plastibell circumcision under local anesthesia in the clinic
At first, local anesthetic cream is being applied onto the penis and prepuce of newborns or infants. After 15-30 minutes, the penile skin is numbed and subsequent injection of long acting local anesthesia becomes nearly painless. The plastibell is placed between the glans of penis and the prepuce. A tight thread is tied tightly over the prepuce at the plastibell level and it strangulates the distal prepuce. With ischemia, the distal prepuce becomes black in color gradually and fell off in 5 to 10 days. The narrow circumferential wound will then heal in few days. The mechanism of plastibell circumcision is similar to the umbilical cord clamp stopping the blood supply of the distal umbilical cord, letting the distal umbilical cord blackened, detaching spontaneously and healing of the residual wound in few days.
Plastibell circumcision under general anesthesia in the hospital
After general anesthesia, long acting subcutaneous local anesthesia is injected to infants or todders’ prepuce to reduce the intraoperative and postoperative pain. The plastibell is placed between the glans of penis and the prepuce. A tight thread is tied tightly over the prepuce at the plastibell level and it strangulates the distal prepuce. With ischemia, the distal prepuce becomes black in color gradually and fell off in 5 to 10 days. The narrow circumferential wound will then heal in few days. The mechanism of plastibell circumcision is similar to the umbilical cord clamp stopping the blood supply of the distal umbilical cord, letting the distal umbilical cord blackened, detaching spontaneously and healing of the residual wound in few days.
The plastibell circumcision is more suitable for newborns, infants and toddlers as there is the advantage of very little post-operative pain comparing with traditional circumcision. The postoperative wound care is simple. During diaper changing or after bathing, normal saline, distilled water or anti-septic solution can be used for wound rinsing. Afterwards, dry the wound with gauze and warm hair dryer. In 2 to 3 weeks, the wound usually heals. The complication risk of this procedure is very low.
Traditional circumcision is a surgical procedure involving cutting of the foreskin with scalpel or scissor and closing of the wound with ordinary surgical sutures. There is usually more blood loss during the surgery and the post-operative pain is usually moderate to severe.
Normal saline, distilled water, or antiseptic solution is required for post operative wound cleansing every time after urination.
Students are expected to be absent from school for about 1 - 2 weeks.
Patients could normally perform moderate exercise four weeks after surgery post-operatively.
Circumcision can be done under local anesthesia in the clinic or under general anesthesia in the hospital.
As the postoperative resting pain is moderate to severe and the wound cleansing pain is severe after traditional circumcision, our surgical specialist seldom employ traditional circumcision for boys.
Comparison of different circumcisions
|Plastibell circumcision||New generation laser circumcision||Traditional Circumcision|
|Indications||Phimosis/ long prepuce/ paraphimosis/ recurrent balanitis / recurrent posthitis/ foreskin diseases/ religious reason/ national tradition/ family tradition/ parental preference/ Southern African|
|Location||Clinic / Hospital|
|Anesthesia||(Clinic) Local anesthesia/ (Hospital) General anesthesia|
|Surgery time||5-10 minutes||15-30 minutes||30-60 minutes|
|Earliest return to school||Immediate after surgery||Immediate after surgery||7-14 days|
|Position of penis posteratively||For newborns, infants or toddlers, just put on regular diapers.
For little boys of age 2 years old or above, both upward penis fixation or letting penis pointing downwards inside paper cup can be used
|Upward penis fixation (the penis is prevented from hitting the surroundings and in turn resulting in minimal pain during walking / postural change)||Letting penis pointing downward inside a paper cup (the penile wound hits the paper cup/ clothings and cause significant pain after every walking step)|
|Post operative wound care||Wound rinsing during urination or change of diapers; use a piece of gauze to dry the tip of penis and blow it dry with fan or hair dryer||No need wound cleaning. Just keep wound dry||Wound cleaning after each urination|
|Post operative pain||Minimal||Nearly zero||Moderate to severe|
|Post operative erection management||No need||Use ice / numbing jelly||None|
|Return to moderate exercise||2 - 3 weeks||2 - 3 weeks||4 - 6 weeks|
|Resume swimming||3 weeks||3 weeks||4 - 6 weeks|
|Post operative off stitches||Wound is healed naturely. Sutures are not used||Seldom
(water soluble sutures are used)
All informations are just for reference. Please consult an experienced surgeon for assessment and enquiry.