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Techniques for neonatal circumcision

Author
Brian T Caldwell, MD
Section Editors
Charles J Lockwood, MD, MHCM
Laurence S Baskin, MD, FAAP
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Circumcision is the surgical removal of all or part of the distal penile foreskin (prepuce). This topic will review the patient selection, analgesia, and techniques for neonatal circumcision, including the Gomco clamp, Plastibell device, and Mogen clamp. Discussions of the risks and benefits of neonatal circumcision, including the controversy surrounding the procedure, and management of complications are presented separately.

(See "Neonatal circumcision: Risks and benefits".)

(See "Complications of circumcision".)

DEVELOPMENT AND ANATOMY

The penis develops as a tri-tubed structure with bilateral corpora cavernosa (erectile bodies) and ventral midline urethra surrounded by corpus spongiosum. The penis is divided into the proximal base, pendulous middle shaft, and distal glans. The corona of the glans and immediately proximal coronal sulcus anatomically differentiate the penile shaft from the glans penis (figure 1 and figure 2).

The foreskin begins development at 12 weeks of gestation as a fold of epithelium at the base of the penis that becomes a bilaminar prepuce covering the entire glans by 18 to 20 weeks. Progression of the foreskin coincides with the development of the penis; therefore, anatomic abnormalities of the penis often result in incomplete or abnormal foreskin. An inner mucocutaneous layer of the prepuce is adherent to the epithelial layer of the glans. Circumcision removes the inner and outer layers of the prepuce as well as the intervening dartos muscle (figure 3) [1].

                           
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Literature review current through: Nov 2017. | This topic last updated: Jul 31, 2017.
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References
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Topic Outline

GRAPHICS