Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Procedures for neonatal circumcision

INTRODUCTION

Circumcision (Latin circumcido, to cut around) is an elective surgical procedure in which the skin covering the end of the penis (prepuce or foreskin) is removed. The three major methods of neonatal circumcision are the GOMCO clamp, Hollister Plastibell, and Mogen clamp. These procedures will be reviewed here. A detailed discussion of the risks and benefits of neonatal circumcision can be found separately. (See "Circumcision: Risks and benefits".)

NORMAL ANATOMY

The penis consists of a root and a body (picture 1). The dorsum of the penis is the surface which faces posterosuperiorly when the penis is erect and anteriorly when the penis is flaccid. The other surface is referred to as the ventral surface (urethral surface). The penis expands distally to form the conical glans penis, whose prominent margin is called the corona of the glans.

The prepuce (foreskin) is formed by a free fold or double layer of skin and fascia that covers the glans penis for a variable extent. Its purpose is assumed to be protection of the glans. A median fold, called the frenulum of the prepuce, passes from the deep layer of the prepuce to a point just inferior to the external urethral orifice. The surface of the foreskin adjacent to the glans is not keratinized.

At birth, the foreskin is firmly attached to the glans because separation of the epithelial layers is not complete. The prepuce is usually sufficiently elastic to permit it to be retracted over the glans penis; however, retracting the foreskin while it is still attached to the glans is painful and could cause injury. The foreskin separates from the glans over time to form the preputial space. Separation has been completed in 50 percent of boys by age three years, and in 95 percent by age five. In a small number of uncircumcised males, partial adhesions leading to accumulation of smegma may persist throughout childhood, and even into adolescence.

TIMING OF CIRCUMCISION

The procedure is performed on healthy term infants who are at least 24 hours old, and preferably less than 10 days of age. This period of observation allows for recognition of abnormalities or illnesses that should be addressed before circumcision (discussed below). Preterm infants are circumcised near the time of hospital discharge.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Snodgrass, WT, Khavari, R. Prior circumcision does not complicate repair of hypospadias with an intact prepuce. J Urol 2006; 176:296.
  2. Pieretti, RV, Pieretti, A, Pieretti-Vanmarcke, R. Circumcised hypospadias. Pediatr Surg Int 2009; 25:53.
  3. Van Howe, RS, Svoboda, JS, Dwyer, JG, Price, CP. Involuntary circumcision: the legal issues. BJU Int 1999; 83 Suppl 1:63.
  4. American College of Obstetricians and Gynecologists. Circumcision. ACOG Committee Opinion #260, American College of Obstetricians and Gynecologists, Washington, DC 2001.
  5. Taddio, A, Stevens, B, Craig, K, et al. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997; 336:1197.
  6. Johnson, A. On an injurious habit occasionally met with in infancy and early childhood. Lancet 1860; 1:344.
  7. Brady-Fryer, B, Wiebe, N, Lander, J. Pain relief for neonatal circumcision. Cochrane Database Syst Rev 2004; :CD004217.
  8. South, MM, Strauss, RA, South, AP, et al. The use of non-nutritive sucking to decrease the physiologic pain response during neonatal circumcision: A randomized controlled trial. Am J Obstet Gynecol 2005; 193:537.
  9. Lander, J, Brady-Fryer, B, Metcalfe, JB, Nazarali, S, Muttitt, S. Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision: A Randomized Controlled Trial. JAMA 1997; 278:2157.
  10. Taddio, A, Ohlsson, K, Ohlsson, A. Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys. Cochrane Database Syst Rev 2000; :CD000496.
  11. Mattson, SR. Routine anesthesia for circumcision. Postgrad Med 1999; 106: online edition. www.postgradmed.com/issues/1999/07_99/mattson.htm.
  12. Blass, EM, Hoffmeyer, LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991; 87:215.
  13. Herschel, M, Khoshnood, B, Ellman, C, et al. Neonatal circumcision. Randomized trial of a sucrose pacifier for pain control. Arch Pediatr Adolesc Med 1998; 152:279.
  14. Nguyen, DM, Bancroft, E, Mascola, L, et al. Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infect Control Hosp Epidemiol 2007; 28:406.
  15. al-Samarrai, AY, Mofti, AB, Crankson, SJ, et al. A review of a Plastibell device in neonatal circumcision in 2,000 instances. Surg Gynecol Obstet 1988; 167:341.
white circle LOG IN
white circle DEMO