I. Overview The most common surgery in the world with origins dating back 15,000 years. 25% of men undergo circumcision, USA 1.2 million cases per year. It is controversial surgery in history.
II. Non-therapeutic, non-religious circumcision is recommended around the world Australia: routine male circumcision is not medically indicated. United Kingdom: discouraged. Canada: Insufficient evidence for routine circumcision. USA: Insufficient evidence to recommend routine neonatal circumcision. Europe: Circumcision is not recommended. Japan: mainly for hygienic reasons.
III. AAP process of circumcision 1975: No valid medical indications for circumcision. 1989: Circumcision has potential benefits. Although there are disadvantages and risks. 1999: Potential benefits, but insufficient evidence to recommend routine circumcision. 2012: Although there are hygienic benefits, they are insufficient to recommend routine circumcision for all male newborns.
IV. HIV prevention: WHO recommends that male circumcision be considered effective for HIV prevention in areas with high risk of HIV transmission and low circumcision rates.
V. Indications and contraindications 1, the age of foreskin retraction: neonates rarely occur, 50% of the Department of cut retraction in 1 year, 90% retraction in 5 years, adolescence: virtually all children can retract.
2, contraindications: Absolute: penile malformations (hypospadias, supra-urethral cleft, megaurethra, micropenis) Relative: propensity for bleeding disorders (family history), prematurity, serious medical problems, syringomyelia large or severely occult penis, lack of adequate surgical skills or equipment.
3. Indications: Therapeutic purposes: prepuce, glans penis, foreskin impaction, acromegaly, limited cancer Preventive purposes: urinary tract infections, sexually transmitted infections, HIV, penile cancer Hygienic purposes; religious culture; parental preference.
VI. Alternative programs: Hormonal ointment is available to deal with prepuce with a success rate of 40%-70%. Dorsal incision or propping up, observation and waiting.
VII. Hazards of prepuce May be accompanied by recurrent foreskin infections or chronic inflammation (BXO).
VIII. Surgical methods: Gomco, circumcision, ring sleeve IX. Complications: Occurring at the time: bleeding (0.1-35%), glans or urethral injury, excision of too much skin Delayed occurrence: infection, insufficient skin, urethral stricture, skin bridges, cysts, adhesions
X. Care of non-circumcised persons Local washing with soap and water is available. 6 months to 1 year of age at birth can begin to help gently retract the foreskin. Let 2-3 year old children start washing themselves and teach them to help retract without violence.