Male Circumcision under Local Anaesthesia by Dr Grothuesmann & Sr WinieDr Dirk Grothuesmann
Male circumcision has been performed on adolescent boys and men for many years, primarily for religious and cultural reasons, such as a rite of passage to mark the transition to adulthood. Beside compelling scientific evidence is shown that men who are circumcised have a 60% reduced risk of acquiring HIV transmitted through heterosexual contact. This presentation guides to a standardized and save procedure to perform Male Circumcision.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Male Circumcision under Local Anaesthesia by Dr Grothuesmann & Sr WinieDr Dirk Grothuesmann
Male circumcision has been performed on adolescent boys and men for many years, primarily for religious and cultural reasons, such as a rite of passage to mark the transition to adulthood. Beside compelling scientific evidence is shown that men who are circumcised have a 60% reduced risk of acquiring HIV transmitted through heterosexual contact. This presentation guides to a standardized and save procedure to perform Male Circumcision.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Recent advances in adhesion prevention post laparoscopic surgery.pptxNiranjan Chavan
Dr. Niranjan Chavan well known Obstetrician & Gynaecologist gave a talk on "Recent advances in adhesion prevention post laparoscopic surgery" at 18th AAGL International Congress on "Unravelling Uterine Issues and Beyond."
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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You can contact me on Telegram or Threema
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Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. • U.S. Centers for Disease Control and Prevention’s Summary of Its
Draft Male Circumcision Recommendations, 2017
50%
HIV infection risk
by a male during penile-vaginal sex
(heterosexual sex)
3. • 2012 Circumcision Policy Statement by the American Academy of
Pediatrics Task Force on Circumcision
Estimated
14/1000
Uncircumcised
Estimated 2/1000
circumcised
The risk of urinary tract infection in
the first year of life in male infants
4. Infection risk of
Herpes simplex virus type-2 (HSV–2)
Types of human papilloma virus (HPV)
which can cause
Penile and other anogenital cancers
30%
5. • Protective effect of childhood/adolescent circumcision on
invasive penile cancer (OR = 0.33; 95% CI 0.13-0.83; 3 studies)
• increased risk of cancer is related to phimosis, which can be the result of poor
penile hygiene
• Circumcision in adulthood was associated with an increased risk of
invasive penile cancer (OR = 2.71; 95% CI 0.93-7.94; 3studies)
Larke NL, et al. Male circumcision and penile cancer: a systematic
review and meta-analysis. Cancer Causes Control. 2011
6. • Circumcised men were less likely than uncircumcised men to have
HPV infection (OR 0.37, 95% CI 0.16-0.85 after adjustment of
confounders)
• Male circumcision was associated with a trend for reduced risk of
cervical HPV and cervical cancer (OR 0.75, 95% CI 0.49-1.14) in the
female partner
Davis MA, et al. Male circumcision decreases high-risk human papillomavirus viral
load in female partners: a randomized trial in Rakai, Uganda. Int J Cancer. 2013
CastellsaguéX, et al . Male circumcision, penile human papillomavirus infection, and
cervical cancer in female partners. N Engl J Med. 2002
7.
8. Surgical procedures
For adults and adolescents
• Forceps-guided method
• Sleeve method
• Dorsal slit method
For infants and children
• Dorsal slit method
• Plastibell method
• Mogen clamp method
• Gomco clamp method
9. The Anatomy and Technique of Penile Block
http://emedicine.medscape.com/article/81077-overview
http://www.circumcisioninformation.com/brown1.htm
24. How to use it to do circumcision
http://prepex.com/device-overview/clinical-procedure/
25. • What’s new technology for circumcision?
•Scalpel
•Electrosurgical Unit
•Laser
26.
27.
28.
29. • 75 boys, aged 6–9 (median 7) years
• circumcision between May 2013 and August 2014.
• Iodine disinfection under general anesthesia, the adhesions on the
coronal sulcus are separated
• The preputial skin is pulled up, a straight hemostat is applied loosely
to the preputium
30. • The incision is made distal to the hemostat using a CO2 laser, applying
350 millijoules energy at 40 pulses/second in continuous mode.
• No bleeding requiring bipolar use was detected after the excision.
• Cyanoacrylate applied after approximating the mucosa and remaining
skin on the penis.
• A chlorhexidine wound covering and Coban bandage for wound care
31. Guillotine method
• The foreskin is released
• Mosquito forceps are applied to the tip of the foreskin ventrally and
dorsally and the foreskin protracted.
• A straight forcep is applied along the lower foreskin above the glans.
• The foreskin is excised by cutting above the forceps using a large
scalpel blade.
• The inner mucosa is trimmed with scissors, leaving an adequate
mucosal cuff.
35. Bleeding
• injury to the frenular artery or dermal cut edges
• Coagulopathy
• firm manual pressure for 10 to 20 minutes
• compression dressing
• circumferential bandage: risk of penile ischemia or urinary retention
36. Infection
• Wound infection: infrequently
• local topical triple antibiotic ointment
• Urine tract infection?
• A reduced risk of UTI is a benefit of circumcision!
38. Urethral injury
• if too much upward traction is placed on the foreskin prior to clamp
application, as it can cause entrapment of the glans in the clamp,
possibly from incomplete separation of the glans from the inner
prepuce.
• the coronal sulcus should be clearly delineated prior to
commencement of the circumcision
40. • Meatotomy
• Sutures to reapproximate the cut edges
scarring on the ventral aspect
of the meatus
41. Glans injury
• The glans is inadequately protected at the time the foreskin is excised,
or if the glans is caught in the clamp apparatus when the foreskin is
excised
• Penile amputation
• successful reattachment is possible if performed within eight hours of injury
• Necrosis of the glans secondary to ischemia
• Electrocautery
42. Excessive skin removal
• wet to dry or antibiotic ointment
dressings results in adequate healing by
secondary intention
• primary re-approximation or skin grafting
44. Epidermal inclusion cyst
• occurs when an island of skin is left to heal underneath the skin of the
penile shaft.
• formal excision of the entire cyst
46. Skin bridges
• possible lysis of adhesions via scalpel
after the application of a topical
anesthetic
47. Cicatrix
• Hypertrophic scar or keloid formation
• Treatment
• Topical betamethasone
• Revision involves excision of the scar, often with skin flap coverage to
substitute for a paucity of penile shaft skin
48. Reference
• Manual for male circumcision under local anesthesia
• Uptodate: circumcision
Editor's Notes
Conclusions of the 2012 Circumcision Policy Statement by the American Academy of Pediatrics Task
Force on Circumcision3
Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health
benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in
the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the
transmission of other sexually transmitted infections.
By using
these rates and the increased risks suggested from the literature, it is estimated that 7 to 14 of 1000 uncircumcised
male infants will develop a UTI during the first year of life, compared with 1 to 2 infants among 1000 circumcised male infants.
Good evidence of the protective effect of male circumcision is available from two of the
large randomized controlled trials in Africa. In the South African study, the
incidence of HSV-2 was 34% lower in circumcised men.73 In the Uganda
study, the risk of HSV-2 infection (adjusted for other factors) was 28% lower in circumcised men.71
The prevalence of infection was lower for the 2 viral types with the highest risk
of causing cancer, however, at 4.7% for
HPV type 16 and 1.9% for HPV type 18.95
There is good evidence that male circumcision
is protective against all
types of HPV infection (nononcogenic
and oncogenic). Two prevalence studies
with good evidence found a 30% to 40%
reduction in risk of infection among
circumcised men.96,97
The evidence does not demonstrate
any relationship between circumcision
and gonorrheal infection.85,86,92–94
6
Mark the intended outer line of the incision, as described above
(Fig. 5.33), with a V shape, pointed towards the frenulum, on the
underside (ventral aspect) of the penis (Fig. 5.34). The apex of the V
should correspond with the midline raphe
It may be necessary in older boys to trim the mucosal layer of
the foreskin to 2–3 mm from the corona. If this layer is left too
long, the suture line can slip back over the glans, constricting it
and making it appear as if the foreskin has not been removed
(“concealed glans”). Control any significant bleeding by
clipping the blood vessel with an artery forceps and then tying.
Bipolar diathermy may be used, if available. Minor bleeding
can be controlled with simple pressure for five minutes.
Check that there is no bleeding. If all is well, the child
can be sent home and looked after in the normal way,
including normal washing and use of nappies. The rim of tissue
distal to the ligature will become necrotic and the Plastibell will
drop off after 5–8 days. Alternatively the infant can be checked
after 36–48 hours and the ligature cut.
(UltraPulse 5000C, Coherent Medical Group, Santa Clara, USA)
(Leukosan Adhesive, BSN Medical, Hamburg, Germany)
Guillotine method: the foreskin is released. Mosquito forceps are applied to the tip of the foreskin ventrally and dorsally and the foreskin protracted. A straight forcep is applied along the lower foreskin above the glans. Care must be taken to ensure that the glans is not caught within the forceps. The foreskin is excised by cutting above the forceps using a large scalpel blade. The inner mucosa is trimmed with scissors, leaving an adequate mucosal cuff.