Circumcisions are commonly performed on the male infant at birth or shortly thereafter. However, the uncircumcised adult may experience difficulty in retracting the prepuce from the glans of the penis because of a stricture (phimosis), which requires surgical intervention, or circumcision may be performed to treat recurrent balanitis or as a religious rite.
If performed on an infant, the procedure may take place in a separate part of the newborn nursery, aseptically suited for the procedure.
Positioning
Supine, with legs slightly apart, or lithotomy.
Children and infants may be placed in a frog-leg position or on a specially designed board.
Incision Site
Circumferentially around the glans penis.
Packs/ Drapes
Child: Pediatric Lap sheet
Adult: Laparotomy pack
Infant: Pediatric Lap sheet or folded towels
Instrumentation
Infants and children: Pediatric Lap tray
Circumcision lamp
Adults: Minor/ very fine tray, Probe and groove director.
Supplies/ Equipments
Basin set
Blades
Needle counter
Catheter
Gauze roll and impregnated gauze strips
Solutions
Procedure
If phimosis is present, a dorsal slit is made. Adhesions are lysed.
A circumferential incision is made at the reflection of the foreskin, which is then excised.
Hemostasis is achieved, and the wound edges are approximated using absorbable suture.
For a very young infant, the skin edges are usually not approximated.
A strip of nonadherent gauze is placed around the incision and is covered with a gauze roll dressing.
A piece of umbilical tape may hold the gauze roll in place.
No other dressing is usually necessary.
Perioperative Nursing Considerations
Consider the special needs of the Jewish patient for a ritual circumcision. All female team members may be asked to leave the room during the procedure.
Instruct the patient the proper way of cleansing the wound.
