This document discusses circumcision, including what it is, common indications such as phimosis and recurrent UTIs, contraindications in children with genital abnormalities, anesthesia methods including penile blocks and caudal blocks, surgical methods using various devices, anatomy, complications including bleeding and infection, and techniques for performing the procedure such as marking the line and suturing.

1. Circumcision
• What is it ?
• Indication:
– PHIMOSIS
• Congenital
• Post infection – balanoposthitis
• Malignancy
– Paraphimosis
– Recurrent UTI - unexplained
– Penile malignancy - prepuce
– Ritual/religious
? Prophylactic
? Dorsal slit

2. Circumcision
• Contraindications : Relative
– Children with hypospadias , epispadias or ambigious
genitalia
• Anesthesia :
– Adult – ring block , penile block
• ? Local anesthetic concentration . No adrenaline
• ? Complication of ring block
– Children – caudal block under iv sedation
• Methods :
– Surgery , various devices

3. Circumcision
• Anatomy

4. Penile block

5. Penile block

6. Phimosis

7. Penile block

8. Ring block

9. Ring block

10. Try to dilate…

11. Release the adhesions….

12. Mark midline….

13. Mark the line of circumcision….

14. Mark the line of circumcision….

15. Introduce the scissors in the space
between ….

16. Cut…

17. …till the mark….

18. 2 layers seen….

19. Cut around…

20. ….around along the mark……

21. ……

22. …..

23. ......

24. ..till the frenulum

25. ..frenulum

26. Ligate the frenular vsls….

27. ……figure of 8 stich

28. ..final cut

29. 2 layers seen around

30. …around

31. Suture them..

32. …suturing

33. …sutures…

34. ….

35. …all around

36. …

37. …sutures

38. Completed sutures…

39. Completed sutures…

40. Dressing

41. Recap

42. Circumcision
• Complications
– Bleeding - ?
– Injury to glans penis
– Retension of urine – clot in meatus
– Penile gangrene
– Infection
– Recurrence of phimosis
– Paraphimosis
– Bowing of penis on erection / chordae