CIrcumcision Flashcards
Circumcision
Indications
Equipment
Consent
Why bipolar?
Perform
Op Note
Indications
Phimosis
Recurrent Balanitis
BXO
Malignant neoplasm of foreskin
Recurrent febrile UTIs
Circumcision
Indications
Equipment
Consent
Why bipolar?
Perform
Op Note
Equipment
Cleaning Equipment
Permanent Marker Pen
Drapes
Minor Procedure Set
No 10 blade (15 blade in children)
Local Anaesthetic (Lidocaine/Bupivicaine mix)
Bipolar Diathermy
Vicryl Rapide 4-0 Sutures
Dressing:
Chloramphenicol
Dressing Gauze
Elastoplast
Circumcision
Indications
Equipment
Consent
Why bipolar?
Perform
Op Note
Consent
Ensure patient details. Explain procedure simply using pictures and baus information leaflet
Alternatives - Steroids, No Surgery
Risks
Bleeding, Infection, Pain
Altered sensation over glans, Glans hypersensitivity, Haematoma, Wound dehiscence,
MEatal Stenosis, Poor Cosmesis
Damage - urethra glans
Anaesthetic risk, Further Procedure, Finding of cancer on histology.
Sign Date Posiiton - Patient to sign and date too
Circumcision
Indications
Equipment
Consent
**Why bipolar? **
Perform
Op Note
Why Bipolar?
Penile artery is end artery. Risk of charge propogation and embolisation.
Circumcision
Indications
Equipment
Consent
Why bipolar?
Perform
Op Note
Perform
Checklist, adequate positioning, cleaning and draping of the patient.
Give penile block:
10 ml 1% lidocaine 10 ml 0.5% Bupivicaine Mixed together
21 Gage needle
Needle 1 cm below pubic symphysis - feel a pop as entering buck’s fascia - Give 15 ml
Give remaining 5 ml at base of penis on ventral aspect
Assess stretched penile length
Use marker to mark - circumferential incision line on internal and external prepuce
Cut along external prepuce marking with blade and then retract foreskin then retract along internal prepuce marking with blade
Use scissiors to perform a dorsal slit connecting the two incisions
Cut away remainder of skin
Ensure haemostasis with bipolar diathermy
Appose edges of external and internal prepuce with 4-0 vicryl rapide
Apply dressing
Sign out
Label specimen
Construct operation note
Circumcision
Indications
Equipment
Consent
Why bipolar?
Perform
Op Note
Indications
Phimosis
Recurrent Balanitis
BXO
Malignant neoplasm of foreskin
Recurrent febrile UTIs
Equipment
Cleaning Equipment
Permanent Marker Pen
Drapes
Minor Procedure Set
No 10 blade (15 blade in children)
Local Anaesthetic (Lidocaine/Bupivicaine mix)
Bipolar Diathermy
Vicryl Rapide 4-0 Sutures
Dressing:
Chloramphenicol
Dressing Gauze
Elastoplast
Consent
Ensure patient details. Explain procedure simply using pictures and baus information leaflet
Alternatives - Steroids, No Surgery
Risks
Bleeding, Infection, Pain
Altered sensation over glans, Glans hypersensitivity, Haematoma, Wound dehiscence,
MEatal Stenosis, Poor Cosmesis
Damage - urethra glans
Anaesthetic risk, Further Procedure, Finding of cancer on histology.
Sign Date Posiiton - Patient to sign and date too
Why Bipolar?
Penile artery is end artery. Risk of charge propogation and embolisation.
Perform
Checklist, adequate positioning, cleaning and draping of the patient.
Give penile block:
10 ml 1% lidocaine 10 ml 0.5% Bupivicaine Mixed together
21 Gage needle
Needle 1 cm below pubic symphysis - feel a pop as entering buck’s fascia - Give 15 ml
Give remaining 5 ml at base of penis on ventral aspect
Assess stretched penile length
Use marker to mark - circumferential incision line on internal and external prepuce
Cut along external prepuce marking with blade and then retract foreskin then retract along internal prepuce marking with blade
Use scissiors to perform a dorsal slit connecting the two incisions
Cut away remainder of skin
Ensure haemostasis with bipolar diathermy
Appose edges of external and internal prepuce with 4-0 vicryl rapide
Apply dressing
Sign out
Label specimen
Op Note
Time, Date, Patient Details
Emergency/Elective
Anaesthetic, Anaesthetist
Surgeon Name
Procedure Name
Describe operation
Follow-Up
FU for BXO/Malignancy in 2/52
Chloramphenicol ointment OD-BD until tube finishes
Can shower after 48 horus but should pat wound dry to facilitate healing
Sutures are absorbable (Don’t need to be removed)
Avoid driving until can perform emergency stop
Safety net- fevers, haematoma, urinarty retention
Avoid masturbation / sexual inter course for 4 weeks
Avoid baths/swimming for 2 weeks
Final cosmetic appearance in 6 weeks
Warn abotu glans changes in sensitvity .
