eMedicine Specialties > Pediatrics: Surgery > Urology

Circumcision: Treatment & Medication

Author: Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Coauthor(s): Santos Cantu, Jr, MD, Department of Pediatrics, Consulting Staff, Christus Santa Rosa Children's Hospital
Contributor Information and Disclosures

Updated: Sep 14, 2006

Treatment

Medical Care

  • Daily cleaning, without forceful retraction of the foreskin, is the only treatment necessary for phimosis in patients without urinary obstruction, hematuria, or preputial pain.
  • Treatment with topical corticosteroids is effective in separating the loose adhesions found between the glans and the foreskin.
  • In 2001, French researchers Berdeau et al used data from form published reports and from claims by private hospitals for children <13 years. They found that topical application of clobetasol or 0.05% betamethasone cream 2 times/day to the foreskin and glans for 4-8 weeks was effective in allowing full retraction of the foreskin in 85% (range, 70-100%) of the patients who had a mean age of 5 years at inclusion. The 15% failure rate was attributed to verifiable cases of lichen scleroticas et atrophicus or nonspecific chronic inflammatory processes. Success was achieved at approximately 10% of the cost of operative circumcision; this result showed a considerable cost-effectiveness with this approach.

Surgical Care

  • Although several techniques are used in neonatal circumcision, all of the methods involve the following common elements:
    • Estimation of the amount of foreskin to be removed
    • Dilation of the preputial orifice to determine the presence of a normal glans and penis without any evidence of hypospadias, epispadias, chordee, or other anomalies
    • Blunt separation of the inner preputial epithelium from the glans
    • Placement of a device designed to ensure hemostasis
    • Removal of the foreskin
  • The 3 most common devices used to date are the Gomco clamp (67%), the Plastibell device (19%) and the Mogen clamp (10%). Both the Gomco clamp and the Mogen clamp are excellent instruments for infants but should not be used in toddlers who weigh more than 5 kg because of an increased risk of bleeding. Cosmetic results are excellent with any of these devices if they are used correctly.
  • In the authors' experience, the Plastibell technique can be used safely for office circumcisions in children up to 10 kg under local anesthesia because this technique induces tissue necrosis by means of suture compression of the foreskin over a plastic ring that protects the glans. Thus, adequate hemostasis is ensured in the older child. The skin sloughs off in 5-7 days, and the ring separates.

More on Circumcision

Overview: Circumcision
Differential Diagnoses & Workup: Circumcision
Treatment & Medication: Circumcision
Follow-up: Circumcision
References
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References

  1. Alanis MC, Lucidi RS. Neonatal circumcision: a review of the world's oldest and most controversial operation. Obstet Gynecol Surv. May 2004;59(5):379-95. [Medline].

  2. Bailey RC, Neema S, Othieno R. Sexual behaviors and other HIV risk factors in circumcised and uncircumcised men in Uganda. J Acquir Immune Defic Syndr. 1999;Nov 1;22(3):294-301. [Medline].

  3. Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int. Feb 2001;87(3):239-44. [Medline].

  4. Cantu S Jr. Phimosis and paraphimosis. eMedicine Journal [serial online]. 2001. Available at: http://www.emedicine.com/emerg/topic423.htm. [Full Text].

  5. Lannon CM, Bailey AGB, Fleischman AR. Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics. Mar 1999;103(3):686-93. [Medline].

  6. Roth DR, Gonzales ET Jr. Disorders of renal development and anomalies of the collecting system, bladder, penis, and scrotum. In: Oski FA, eds. Oski's Essential Pediatrics. 2nd ed. Wolters Kluwer;1994: 1763-5.

  7. Schoen EJ. Ignoring evidence of circumcision benefits. Pediatrics. 2006;118(1):385-7. [Medline].

  8. Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS. 2000;14(15):2361-70. [Medline].

  9. Wiswell TE, Hachey WE. Urinary tract infections and the uncircumcised state: an update. Clin Pediatr (Phila). Mar 1993;32(3):130-4. [Medline].

  10. Wolbars AL. Circumcision and penile cancer. Lancet. 1932;1:150-3.

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Further Reading

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Keywords

circumcision, prepuce, foreskin, peritectomy, prepuce excision

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Contributor Information and Disclosures

Author

Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Carlos A Angel, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, British Association of Paediatric Surgeons, Children's Oncology Group, International Children's Continence Society, International Pediatric Endosurgery Group, New York Academy of Sciences, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Coauthor(s)

Santos Cantu, Jr, MD, Department of Pediatrics, Consulting Staff, Christus Santa Rosa Children's Hospital
Disclosure: Nothing to disclose.

Medical Editor

M David Bomalaski, MD, FAAP, Chief of Medical Staff, 3rd Medical Group, Elmendorf Air Force Base
M David Bomalaski, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Nothing to disclose.

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Chief Editor

William J Cromie, MD, MBA, President and Chief Executive Officer, Health Care, Capital District Physicians' Health Plan
William J Cromie, MD, MBA is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, Medical Society of the State of New York, Société Internationale d'Urologie (International Society of Urology), Society for Pediatric Urology, Society of University Urologists, and Society of Uroradiology
Disclosure: Nothing to disclose.

 
 
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