Circumcision is a surgical removal of a narrow foreskin (prepuce).
What are the reasons for circumcision?
The most frequent medical reasons for circumcision include:
- Phimosis – a very narrow foreskin which cannot be pushed down exposing the head of penis (glans), bulging of the foreskin during urination, difficult urination;
- Balanitis, posthitis – recurring inflammations of the glans and foreskin (balanitis, posthitis);
- Tearing and bleeding frenulum after sexual intercourse;
- Emergency circumcision in case of paraphimosis – retracted foreskin that cannot be brought forward over the glans which is compressed and starts swelling.
Circumcision can be also performed at the patient’s request.
How is surgery done?
Having consulted an urologist and anaesthetist, the patient shall come to the clinic on the scheduled date for surgery. The surgery is performed under a local or a general anaesthesia. The surgery involves cutting and removal of the foreskin which inner and outer layers are then brought together placing individual sutures (whether absorbable or non-absorbable). The length of the surgery is 30-60 min. After the surgery, a bandage is applied over the glans to the area of incision. The patient shall be monitored at the clinic for 3-6 hours and discharged thereafter to continue treatment as an outpatient provided, however, that the post-operative course is normal. Patients are provided detailed information concerning further care upon discharge.
What are likely complications?
At the early postoperative period, there is a risk of bleeding or infection, like in case of any other surgical intervention. The risk for such complications is low, accounting for 1-2%. Occasionally, the sensitivity of the glans may increase after the surgery or decrease during later postoperative periods. The risks of long-term complications include scar formation, partial aesthetic satisfaction with the surgical outcome.
What happens after the surgery?
Postoperative pain is usually not acute and, if necessary, can be managed taking oral analgesics. If the bandage slips, it is not necessary to place it back unless bleeding has not stopped. There may be some tingling when first urinating after the surgery. Yet, these symptoms are usually not expressed and short-lasting. There also may be some skin intumescence and redness of the glans which are normal postoperative symptoms.
The bandage shall be removed the next day after the surgery and antiseptic baths shall be applied thereafter. Absorbable sutures usually disappear in 2-3 weeks after the surgery. Sometimes, sutures need to be removed 3-4 weeks later in case of failed absorption. Non-absorbable sutures have to be removed after about 10 days.
Some patients may have painful erections during the early postoperative period. Therefore, sexual stimulation should be avoided. It is recommended to resume sexual activity 4-6 weeks after the surgery.
In case of the normal postoperative course, driving is not recommended for 2-4 days. Patients can usually return to work after 2-4 days, unless they do heavy manual work in which case it requires one week to be back to work.