John J. Bauer, M.D.
www.flinturology.com Urology Services, Inc.
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Contents
General information
Pre-operative instructions
Risks and Complications
Detailed Surgery Description
Family waiting instructions
Post-operative instructions
Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. To print a selection, highlight the section you want to print using your mouse, then click on print, and then in the print menu, choose "selection."
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
This procedure is usually done after birth by the OB doctor before leaving the hospital. However, if the foreskin has been left after birth, there are many reasons to have it surgically removed the most serious is chronic infection of the foreskin, bladder and kidneys. The foreskin can be constricting as the child grows older, so it cannot be retracted over the glans (head) of the penis for regular cleaning, causing obstructive urination with a ballooning of the foreskin with urination.
Note from the Doctor:
Congratulations on the birth of your new son! We have been asked by your pediatrician to perform an elective circumcision. This involves removal of the excess foreskin of the penis. Some babies can become nauseated during the procedure and may vomit food or milk is in the stomach. It is important that the child not eat for 2 hours before the procedure to help prevent vomiting and possible aspiration (vomit getting into lungs). A prescription for EMLA Cream, a numbing ointment, will be given to you. This cream comes with a dressing called Tegaderm, you will be applying the cream to the top of the penis only and put the dressing over the penis 1 hour prior to the procedure. A special surgical clamp is used to perform this procedure safely. Occasionally, some dissolvable sutures will be used to help keep the edges of the foreskin together. These will not require removal and will usually fall off within the ten days. The care of the circumcision is really quite simple and requires very little attention. The dressing will fall off within 24-72 hours and no special dressing needs to be applied. If the penis becomes heavily soiled with stool you may choose to gently cleanse it using a cotton ball soaked with peroxide. Neosporin ointment must be placed around the area of incision with every diaper change.
Your pre-operative appointments
Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.
Change In Health Status
Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.
Pre-Operative Medication Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:
Pre-Operative Diet Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:
Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.
Pre-Operative Cleaning Instructions (bathing and showering instructions)
Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:
On The Day Of Surgery
The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.
After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.
Time To Arrive For Your Surgery
During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.
ARRIVAL TIME:
WHERE TO ARRIVE:
The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.
Indications:
Patient is a male patient with redundant prepuce/phimosis/ whose parent(s) desire(s) circumcision.
Alternatives:
To include watchful waiting and topical steroids have been discussed. They elect to have circumcision performed.
Risks/Complications:
The risks and complications of the procedure where extensively discussed with the parent(s). The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately.
The specific risks of this procedure include, but are not limited to: removal of to little skin, removal of too much skin, injury to the glans and meatal stenosis.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
To view the actual printable form for this surgery, click here: Counseling Note for Pediatric Circumcision. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
Indications: Male patient with redundant foreskin / phimosis.Sample Procedure Dictation:
The patient was given general anesthesia, placed in the supine position and then prepped and draped in the usual standard sterile manner. A standard sleeve resection of the foreskin was performed. A circumferential pen marking was made 5mm below the corona of the glans while the foreskin was retracted. A second circumferential pen marking was made with the foreskin pulled over the glans approximately 5mm above the corona. We then proceeded to incise the foreskin at the two marked areas and the subcuticular tissues were dissected to isolate the foreskin. This allowed complete resection of the sleeve of foreskin. All bleeders were identified and bovied. The two skin edges were brought together with interrupted 4-0 chromic sutures. Bacitracin ointment was placed over the closure and 4X4's were wrapped about the penis. A segment of Coban wrapping was applied in a manner to stem any venous bleeding but loose enough not to compromise the blood flow of the penis. Patient was then awaken from anesthesia without complications and transferred to the Recovery Room (RR). The patient arrived to the RR in stable condition and without complications.
To the family and friends of patients undergoing surgery.
SCHEDULED STARTING TIME OF SURGERY:ESTIMATED LENGTH OF SURGERY:
You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.
The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.
We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.
Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.
General Instructions
Special Instructions for Endoscopic Procedures
Circumcisions, Penile or Scrotal Surgeries
Special Instructions for Patients with Catheters
Contacting Your Physician
Dr. Bauer can be contacted by calling the number at the top of this page. You may also call the hospital to have them contact us. Please do not hesitate to call with any questions or concerns.
Frequently Asked Questions after surgery
This section is under construction.