Techniques for neonatal circumcision
- Brian T Caldwell, MD
Brian T Caldwell, MD
- Assistant Professor, Pediatric Urology
- University of Colorado School of Medicine
- Children's Hospital Colorado
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr, MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
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 "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) .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DEVELOPMENT AND ANATOMY
- TIMING OF PROCEDURE
- PAIN CONTROL
- Our approach
- Local topical anesthetics
- Penile nerve block
- - Anatomy for nerve block
- - Dorsal penile block
- - Ring block
- Non-pharmacologic adjuncts
- PRE-PROCEDURE PREPARATION
- Informed consent
- Examination of penis and scrotum
- Choice of technique
- Initial steps
- Gomco clamp
- Mogen clamp
- POST-CIRCUMCISION CARE
- COMPLICATIONS AND MANAGEMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS