Circumcision

Definition

• The excision of the foreskin (prepuce).
• Circumcisions are commonly performed on the male infant at birth or shortly thereafter. However, the uncircumcised adult may experience difficulty in retracting the prepuce from the glans of the penis because of a stricture (phimosis), which requires surgical intervention, or circumcision may be performed to treat recurrent balanitis or as a religious rite.
• If performed on an infant, the procedure may take place in a separate part of the newborn nursery, aseptically suited for the procedure.

Positioning

• Supine, with legs slightly apart, or lithotomy.
• Children and infants may be placed in a frog-leg position or on a specially designed board.

 Incision Site

• Circumferentially around the glans penis.

Packs/ Drapes

• Child: Pediatric Lap sheet
• Adult: Laparotomy pack
• Infant: Pediatric Lap sheet or folded towels

Instrumentation

• Infants and children: Pediatric Lap tray
• Circumcision lamp
• Adults: Minor/ very fine tray, Probe and groove director.

Supplies/ Equipments

• Basin set
• Blades
• Needle counter
• Catheter
• Gauze roll and impregnated gauze strips
• Solutions

Procedure

1. If phimosis is present, a dorsal slit is made. Adhesions are lysed.
2. A circumferential incision is made at the reflection of the foreskin, which is then excised.
3. Hemostasis is achieved, and the wound edges are approximated using absorbable suture.
4. For a very young infant, the skin edges are usually not approximated.
5. A strip of nonadherent gauze is placed around the incision and is covered with a gauze roll dressing.
6. A piece of umbilical tape may hold the gauze roll in place.
7. No other dressing is usually necessary.

Perioperative Nursing Considerations

1. Consider the special needs of the Jewish patient for a ritual circumcision. All female team members may be asked to leave the room during the procedure.
2. Instruct the patient the proper way of cleansing the wound.