Circumcision (circumcision) in men

Circumcision (circumcision) - partial surgical removal of the prepuce.

Prevalence

The most common surgery for men. The prevalence varies in different countries: 50% in Canada, 60-90% in the USA, 90-95% in Israel.

[1], [2], [3], [4], [5]

Indications for circumcision in men

Most often, circumcision is carried out for religious reasons, which, as a rule, also regulate the time of the procedure and the person responsible for its implementation.

In 1989, the Circulatory Commission of the American Academy of Pediatrics stated that "circumcision in newborn boys has potential medical benefits and advantages, as well as disadvantages and a certain risk." The commission also stated that there is no medical indication for circumcision of newborn boys.

For medical reasons, circumcision is rarely performed. These indications include the incommensurability of the foreskin (especially when combined with obstruction of the urinary tract), phimosis and paraphimosis (infringement of the glans penis with extreme flesh, manifested by acute pain and swelling of the glans penis due to venous outflow disturbance.), And possibly also recurrent infection of the urinary system and / or STDs

Potential benefits of circumcision

Circumcision (circumcision) contributes to the purity of the genitals. The procedure does not exclude the need for proper personal hygiene, but facilitates its implementation.

The procedure reduces the incidence of infections of the urinary system in male infants from 1 to 0.1%

May reduce the risk of transmission of certain STDs (such as HIV infection)

Cancer of the penis is a disease of the elderly, observed at a frequency of 1 in 600 men who have not undergone circumcision. Circumcision almost completely eliminates the risk of developing this disease. However, in the pathogenesis of penile cancer, an equal value, perhaps, is the non-observance of the rules of personal hygiene.

Circumcision (circumcision) can prevent cervical cancer in sexual partners of men infected with HPV who have not been circumcised.

Circumcision (circumcision) avoids circumcision at a later age, when the procedure is more complex and more traumatic for the patient. 10% of men who have not undergone circumcision, subsequently have to carry out the procedure for medical reasons.

The technique of circumcision (circumcision)

It is necessary to obtain the informed consent of the parents.

Before the operation, the external genitalia should be examined. When carrying out the operation, the child must be carefully fixed.

During the operation, the infant experiences pain and discomfort. Anesthesia is not performed in all cases. The preferred method of anesthesia is not defined. Effective local anesthesia (blockade of the dorsal nerve of the penis). Do not use epinephrine. Surface anesthesia may be effective (5% gel with lidocaine / prilocaine). General anesthesia is not justified.

Contraindications to circumcision in men

Absolute contraindications: the presence in the infant (or family history) of increased bleeding or malformation of the penis (such as hypospadias, in which the skin of the foreskin is used as a flap for surgical correction of the defect). Circumcision is an optional procedure, it should only be performed by healthy babies.

Relative contraindications: prematurity, age less than 24 hours and very small penis (micro penis), which can be the result of a fusion between the glans penis and scrotum.

[6], [7], [8], [9], [10], [11], [12], [13]

Complications of circumcision

Complications of circumcision occur in 0.2-0.6% of cases. The most frequent complication is marked bleeding. Other immediate complications include postoperative infection, formation of a hematoma, damage to the penis, removal of an excessively large skin flap (denudation)

• Infectious complications after circumcision often develop when using the device Plastibolla, which is imposed for a few days on the foreskin, until it happens necrosis and falling away.
• Late complications, such as stenosis of the external opening of the urethra, develop rarely. As for the acuteness of sexual sensations. Master and Johnson did not reveal any difference between men with and without circumcision.
• Severe complications are extremely rare and in all cases are caused by a violation of the technique of the operation (for example, complete destruction of the penis during electrocautery or ischemic necrosis due to the use of a mixture of lidocaine and adrenaline for local anesthesia).

[14], [15], [16], [17], [18]