(a) The scrotal flaps are made prior to lifting the penis from the
scrotum. A catheter is placed in the penile urethra. By dissection, the penis with its
established new urethra is lifted off the scrotum.
(b) The flaps are sutured, providing the proper penoscrotal angle.
The scrotal fascia of the flap may be sutured.
(d) A catheter may be placed. The wound is dressed.
(1) This procedure is the excision of the foreskin (prepuce) of the glans
penis. It is done prophylactically in infancy and is commonly performed in the newborn
period. For Jewish patients, this may be a religious rite performed by a rabbi. Provision
should be made in a hospital to observe the religious needs and preferences of parents
in this regard.
(2) Circumcision is done for the relief of phimosis, a condition in which the
orifice of the prepuce is too small to permit easy retraction behind the glans.
Circumcision may be done to relieve paraphimosis, a condition in which the prepuce
cannot be reduced from a retracted position.
b. Patient Preparation. Newborn infants are generally positioned on specially
constructed boards that facilitate restraint by immobilizing the limbs and exposing the
genitalia. No anesthesia is used for newborn infants. Older patients may be given a
general or local anesthetic.
c. Operative Procedure.
(1) If the foreskin is adherent, a probe or hemostat may be used to break up
adhesions. The foreskin is grasped with an Allis forceps and stretched taut over the
glans. A superficial, circumferential incision is made in the skin at the level of the
coronal sulcus at the base of the glans. A straight hemostat may be placed at the
medial dorsal aspect and the foreskin cut from the meatus to the sulcus with a straight
scissors or scalpel. The foreskin is then completely excised at the level of the sulcus.
Bleeding vessels are clamped with mosquito hemostats and tied with fine number 2-0
plain gut ligatures.
(2) The raw edges of the skin incision are approximated along the corona
with fine number 4-0 chromic sutures on Atraumatic needles. The wound may be
dressed with petrolatum or hemostatic gauze, if desired.