Perioperative Circumcision.docx

Perioperative generally refers to the three phases of surgery: preoperative, intraoperative, and postoperative. Preoperative details 

Obtaining proper informed consent before the procedure is critical. In particular, inform patients of potential risks, which include bleeding, hematoma formation, infection, suture disruption, inadvertent injury to the urethra or glans, removal of too much or too little skin, and a change of sensation during intercourse.

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Patients undergoing circumcision for recurrent balanitis should be free from infection before the procedure.

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Circumcision may be performed in the office under a local anesthetic or in the operating room under a regional or general anesthetic.

Intraoperative Surgical repair for phimosis  

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With the patient in a supine position, the genital area is prepared with povidoneiodine solution. Shaving or clipping of the pubic hair is usually unnecessary. A general anesthetic is recommended in children. A local anesthetic may be used in adults. Local anesthesia is accomplished by administering a dorsal penile nerve block followed by a ring block. A mixture of equal volumes of 0.5% bupivacaine (Marcaine) and 12% lidocaine (Xylocaine) without epinephrine is common. A potential complication of epinephrine use is local tissue ischemia. The maximum recommended dose of lidocaine without epinephrine is 4.5 mg/kg, or 315 mg in a 70-kg male.

Postoperative circumcision Adult circumcision 

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Following adult circumcision, many urologists choose not to use a dressing. However, either petroleum jelly and sterile gauze or Xeroform petrolatum gauze may be wrapped around the penis circumferentially, followed by application of sterile gauze and a nonadhesive elastic wrap. Discharge medications should include oral narcotics. The dressing is removed 24-48 hours after surgery. The patient should wear loose-fitting briefs after surgery, and he may shower but should wash gently around the incision site. Full recovery may require 4-6 weeks of complete sexual abstinence.