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1. STEPWISE APROACH TOSTEPWISE APROACH TO
ADULT MALEADULT MALE
CIRCUMCISIONCIRCUMCISION
BY:BY:
Adeloye Amoo Adeniji (MBBS; MMedAdeloye Amoo Adeniji (MBBS; MMed(stell)(stell);FCFP;FCFP(SA)(SA) ))
Bishop Lavis Day HospitalBishop Lavis Day Hospital
Northern / Tygerberg substructure.Northern / Tygerberg substructure.
Cape Town, South Africa.Cape Town, South Africa.

2. CONTENTCONTENT
1.Screening for circumcision.1.Screening for circumcision.
2.Bed side investigation .2.Bed side investigation .
3.Operating room preparation.3.Operating room preparation.
4.Describing the procedure.4.Describing the procedure.
5.Patients’ necessary information5.Patients’ necessary information
6.Conclusion.6.Conclusion.

3. Screening for Adult maleScreening for Adult male
circumcision.circumcision.
1.1. Examining the pelvis to rule out:Examining the pelvis to rule out:
a. Lymphadenopathy.a. Lymphadenopathy.
b. Ulceration.b. Ulceration.
c. Scrotal swelling / penile discharge.c. Scrotal swelling / penile discharge.
2.Examine the penis to rule in:2.Examine the penis to rule in:
a.a. intact, retractable prepuce.intact, retractable prepuce.
b.b. Normal gland penis.Normal gland penis.
c.c. Normal urethral in location and size.Normal urethral in location and size.

4. BED SIDE INVESTIGATIONSBED SIDE INVESTIGATIONS
A.A. Blood pressure and pulse rate.Blood pressure and pulse rate.
B.B. HeamoglobinHeamoglobin
C.C. Random blood glucoseRandom blood glucose
D.D. Rapid HIV testRapid HIV test
E.E. Rapid RPRRapid RPR
F.F. Urine dipstixUrine dipstix
G.G. Others and compartible with the base lineOthers and compartible with the base line
medical conditionmedical condition

5. OPERATING ROOMOPERATING ROOM
PREPARATIONPREPARATION
Operating theatre is the mostOperating theatre is the most
ideal.ideal.
Surgery could be done as aSurgery could be done as a
bed side procedure in anbed side procedure in an
aseptic room with goodaseptic room with good
ventilationventilation..

6. Describing The ProcedureDescribing The Procedure
Aseptic ProcedureAseptic Procedure
Ring blockRing block
Technique / ManovoureTechnique / Manovoure
Maintaining HaemostasisMaintaining Haemostasis
Wound closureWound closure
Wound dressingWound dressing
Post operative observationPost operative observation
Post operative wound carePost operative wound care
Patient’s informationPatient’s information

7. Aseptic ProcedureAseptic Procedure
1.1. Cleaning of the operative field withCleaning of the operative field with
antiseptic lotion e.g. Betadine.antiseptic lotion e.g. Betadine.
2.2. Draping the patientDraping the patient
3.3. Face mask for the surgeon and theFace mask for the surgeon and the
assistant.assistant.
4.4. Scrubbing, Gowning and Gloving by theScrubbing, Gowning and Gloving by the
surgeon and the assistant…Use of apronsurgeon and the assistant…Use of apron
is acceptable.is acceptable.

8. RING BLOCKRING BLOCK
Local anaesthesia: plain lignocaine.Local anaesthesia: plain lignocaine.
Concentration: 1% or 2%Concentration: 1% or 2%
Dosage : 1ml + 0.1ml/kg.Dosage : 1ml + 0.1ml/kg.
Approach: Dorsal or frenular approachApproach: Dorsal or frenular approach
Distribution: Ring around the base of penisDistribution: Ring around the base of penis
Aim: Blockage of the pudendal nerveAim: Blockage of the pudendal nerve
supply to the penis.supply to the penis.

9. SURGICAL TECHNIQUES.SURGICAL TECHNIQUES.
Forceps guided manouevreForceps guided manouevre
Dorsal slitDorsal slit
Sleeve resectionSleeve resection
Prepex devicePrepex device
PlastibellPlastibell
GomcoGomco
Smart clampSmart clamp
Zhenxi ring.Zhenxi ring.

10. HAEMOSTASIS CONTROL.HAEMOSTASIS CONTROL.
Used of diathermy (25mvUsed of diathermy (25mv
to 35mv)to 35mv)
Manual tie of bleedingManual tie of bleeding
vessels if no diathermy.vessels if no diathermy.

11. CIRCUMCISION KIT.CIRCUMCISION KIT.

12. WOUND CLOSUREWOUND CLOSURE
Use 3/0 vincryl:Use 3/0 vincryl:

Matresses sutures at 3/clock, 6clock and 9/clockMatresses sutures at 3/clock, 6clock and 9/clock

Simple interrupted sutures in between depending onSimple interrupted sutures in between depending on
the penile sizethe penile size
Inspect round the sutured woundInspect round the sutured wound

Ensure no bleeding site or heamatomaEnsure no bleeding site or heamatoma

Ensure good wound apositionEnsure good wound aposition

Take care of redundant tissuesTake care of redundant tissues

13. WOUND DRESSING.WOUND DRESSING.

Jelonet dressing around theJelonet dressing around the
wound:wound:
Raise the penis up , pointingRaise the penis up , pointing
to the umbilicusto the umbilicus
Ensure this position toEnsure this position to
prevent swelling.prevent swelling.
Patient to wear supportingPatient to wear supporting
under wear for next fewunder wear for next few
weeksweeks

14. Post operative carePost operative care
Immediate post operativeImmediate post operative

Repeat the blood pressure and pulse rateRepeat the blood pressure and pulse rate

Ensure patient is clinically stableEnsure patient is clinically stable

Discharge on analgesics (panadol andDischarge on analgesics (panadol and
NSAID)NSAID)
48 Hours post op48 Hours post op

Wound inspection and dressing.Wound inspection and dressing.

Ensure no haematoma /swelling or sepsis.Ensure no haematoma /swelling or sepsis.

15. Salted water solution dressing after 48Salted water solution dressing after 48
hours.hours.
Swelling , unusual pain and discolourationSwelling , unusual pain and discolouration
must be reported immediately.must be reported immediately.
Analgesia to be taken 6 hourly.Analgesia to be taken 6 hourly.
No sex for the next 6 weeks postNo sex for the next 6 weeks post
operation.operation.
PATIENTS’ INFORMATIONPATIENTS’ INFORMATION

16. CONCLUSIONCONCLUSION
Circumcision does not prevent HIV:Circumcision does not prevent HIV:

It only reduces the risk of HIV infection fromIt only reduces the risk of HIV infection from
infected partner.infected partner.

Condom use is still very important for theCondom use is still very important for the
circumcisedcircumcised
Circumcision is not a cure for HIVCircumcision is not a cure for HIV

ARV should still be continuedARV should still be continued
•

17. THANK YOU.THANK YOU.