Circumcision

Question 1

What is the difference between phimosis and paraphimosis

Answer 1

Phimosis Is inability to retract prepuce behind glandular sulcus

Paraphimosis occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis.

Question 2

Discuss the management of phimosis

Answer 2

Primary Phimosis
Conservative for Primary Phimosis
EAU guidelines
Treat Primary Phimosis after 2 years
Corticoid ointment BD over 30 days as first line
Success rate > 90 %
No side effects
Circumcision if Recurrent Balanoposthitis / UTIs or in patients with Urinary tract abnormalities

Secondary
Circumcision for all patients with secondary phimosis
Circumcision significantly reduces bacterial colonization of the glans.

Question 3

Discuss management of paraphimosis

Answer 3

-Penile Block – local with NO ADRENALIN
-Constant pressure on glans with attempt to retract foreskin over glans
Failure  Dorsal band incision
Elective circumcision recommended later

Question 4

Lust the indications of circumcision (5)

Answer 4

Pathological phimosis
Paraphimosis
Recurrent balanoposthitis (infx of glans-balanitis, infx of prepuce-posthisis)
Carcinoma of penis
Condylomata accumulata -warts
Inadequate prev circumcision
Foreskin trauma

Question 5

List the advantages of circumcision

Answer 5

Prevents STIs
Prevents penile ca
Prevents HIv

Question 6

List the contraindications of circumcision

Answer 6

Neonatal
Congenital penils abnormalities-hypospodias
-chordee
-buried penis
- webbed penis

Question 7

What type of circumcision is performed in neonates

Answer 7

Gomco Clamp / Plastibell

Question 8

What type of circumcision is performed in adults

Answer 8

Sleeve circumcision

Question 9

List some of the complications of circumcision

Answer 9

Bleeding\Hematoma
Infection
Removal of excessive / Inadequate skin
Fistula formation if urethral injury
Hyperesthesia of glans - resolves

Question 10

Discuss management of hypospodias

Answer 10

Don’t circumcise !
Correct chordee (straighten penis)
Urethral reconstruction
Surgical correction usually around 2years of age, distal hypospodias may not not need surgery