CIRCUMCISION lect

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CIRCUMCISION : 

CIRCUMCISION Dr. Hrushikesh Kharosekar Assistant Professor MNR Medical college,Sangareddy.

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PHIMOSIS- - Phimosis is overdiagnosed. - Physiological adhesions are present between foreskin and glans upto 6 years of age. True phimosis in boys with scarring of prepuce which is not retractable. Balnitis Xerotica Obliterans(BXO) Treatment- Circumcision

INDICATIONS- : 

INDICATIONS- Infants & young boys- -social & religious -Phimosis - paraphimosis -BXO -Balanposthitis -Recurrent UTI -Trauma (Zip injury) Adults- -Balanoposthitis -Ca Penis for Radiotherapy -Difficulty in intercourse

CONTRAINDICATION- : 

CONTRAINDICATION- Hypospadias

TECHNIQUE- : 

TECHNIQUE- INFANTS- Gullitone method ADULTS- 3 Artery forceps method PLASTIBEL METHOD

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ANAESTHESIA- Ideal- General anesthesia also Local Anesthesia in Adults. POSITION- Supine

1. 3 ARTERY FORCEPS METHOD : 

1. 3 ARTERY FORCEPS METHOD Parts are prepared, painted and drapped. Small sized mosquito forcep is passed between prepuce and glans to separate the adhesions. Prepuce is retracted. Smegma is cleaned with betadine. 3 small sized artery forceps are applied at 2,6 and 12 o clock position. Prepuce is clamed at 12 o’clock position with straight artery forceps and removed. Prepuce is now cut over this groove involving both skin and mucosa. Now prepuce is cut on both sides from 12o’clock position to 6 o’clock position.

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7. Haemostasis is achieved with chromic catgut. We ligate Dorsal vein of penis, Frenular veins. 8. At 6o’clock position Figure of 8 stitch is taken and simple sutures are taken at 12, 3, 9 o’clock position. 9. Dressing is done.

2. GULLITONE METHOD : 

2. GULLITONE METHOD Prepuce is hold at 12 and 6 o’clock pisition with artery forceps. Assitant holds these two forceps. With left thumb and index fingers glans is protected. Straight artery forceps is used to clamp prepuce parallel to corona. Clamp is removed and prepuce is cut over this groove. Mucosa is cut separately. Haemostasis is achieved with chr catgut sutures.

Complications- : 

Complications- Haemorrhage Infection Injury to glans Excessive excision of skin

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