Circumcision is the most common surgical procedure performed on children in Turkey. It is performed by cutting and removing the foreskin surrounding the glans penis.
In Which Situations Is Circumcision Performed?
The narrow tip of the foreskin is among the most common medical reasons for circumcision. In newborn children, the foreskin often appears closed. The main problem is the child's difficulty urinating. In other words, if the child has difficulty urinating and the foreskin swells like a balloon, then circumcision is necessary. In such cases, it is definitely not recommended to expand the tip of the foreskin or to open it by peeling it back. Because this is a very painful procedure and can cause infection of the area by creating cracks in the skin.
In cases where the foreskin cannot be corrected again due to edema and stenosis after it is peeled back, emergency circumcision is required. This is a very painful condition for the child and can be relieved by circumcision.
Circumcision is recommended for recurrent urinary tract infections if the cause is not found. If the foreskin is a source for microorganisms, it can give therapeutic results. Circumcision in children with urine leakage from the bladder to the kidneys or enlarged kidneys has been shown to reduce urinary tract infections.
In which cases should circumcision be avoided?
In structural diseases in the penis, circumcision is performed together with the main surgery and should not be performed before it. Circumcision is not performed in children whose urethra is found to be under the penis, because the foreskin can be used during surgery and circumcision is performed at this time. Apart from this, other diseases in which circumcision cannot be performed beforehand are the presence of the urethra above the penis, embedded penis, and the appearance of the penis adhered to the bag.
Circumcision should be performed in preterm babies and children with bleeding disorders only under appropriate time and conditions.
Complications of circumcision:
Circumcision is an easily tolerated surgical procedure with a very low risk when performed in competent hands and under appropriate conditions. However, like any surgical procedure, it has minor and major complications.
Minor complications
- Bleeding
- Infection (inflammation)
- Inadequate circumcision
Major complications:
- Amputation of the penis
- Penile necrosis (decay with impaired circulation)
- Glans (penis head) injuries
- Urinary orifice narrowing
- With curvature due to disproportionate cutting
- Fistula formation (urinary duct injury)
What should be done before circumcision?
The child must be examined by a doctor before circumcision. Because it may be possible to detect many diseases that may be overlooked. Structural abnormalities in the penis, hernia, undescended testicle are just the most common ones. In addition, a positive communication between the doctor and the older children who will be circumcised under local anesthesia is ensured and thus the stress of the child during circumcision can be reduced. However, there are also diseases that are not seen during the examination but can be detected during circumcision. Hypospadias (having the urethra at the bottom), which can be detected after the foreskin is closed and opened during circumcision, can rarely be seen. In this case, families are informed and the procedure is converted to circumcision with hypospadias repair surgery.
Which anesthesia is used for circumcision?
Local anesthesia is the usual type of anesthesia in circumcision and is applied by administering anesthetic medication around the penis with a needle. This is considered sufficient by most families and circumcision with local anesthesia is requested. The advantage of this method is that no pre-procedure is required except for questioning the bleeding disorder. However, the disadvantage is that the child experiences both surgical stress and lifelong psychological trauma that we may not be able to measure yet. These negative effects are considered to be minimal in newborn circumcisions and in older, compliant and prepared children.
Circumcision with sedation is performed by administering a sedative, that is, a drug that induces sleep or drowsiness, usually in the form of a syrup. Local anesthesia is applied to the child again, but there is no stress or restlessness in the child during these procedures. After the circumcision, the child is kept under observation for about an hour for the effect of the drug to wear off. This method is preferred in children under the age of one year, as the drug will be given in high doses in older children, general anesthesia is more appropriate instead. The sedating drug causes temporary agitation in some children, that is, unconscious crying and restlessness. This ends with the effect of the drug, but it causes fear in families because of the feeling that the child is in pain.
Circumcision with general anesthesia is performed with the child completely asleep. Local anesthesia is also used during the procedure. In this way, the child does not experience stress, distress and restlessness due to the surgical procedure or the operating room environment. The surgeon performing the procedure can perform the surgical procedure more comfortably and carefully because the child is comfortable. So this is actually the most comfortable method for the child. It is not a method that unnecessarily increases the risk in the child as it is thought. However, the child should be hungry for 3-6 hours depending on the age before the blood test and circumcision.
What is Newborn Circumcision?
Circumcisions performed within the first week or month after birth are called newborn circumcision. This circumcision has advantages over circumcisions performed at other ages. These advantages are that it can only be performed with local anesthesia, it heals quickly, both pain control and care after surgery are very easy, and perhaps it is the time when the child will experience the least stress. The difficulties are that circumcision is probably the most gentle age and should definitely be performed by a specialist doctor who performs this procedure frequently. Because the newborn period is the time when circumcision is most prone to complications.
What are the Benefits of Circumcision?
There are many studies reporting that circumcision reduces urinary tract infections in children. In addition, it is known to reduce the incidence of venereal diseases in older ages and to reduce the risk of penile carcinoma and cervical cancer.
