Surgical Cut Method – Dr Anthony Dilley

One of the most important aspects about operating on an awake newborn is adequate pain relief. The penis can only be rendered completely numb, after two local anaesthetic injections are administered – one above and one below the penis. These injections are as painful as those given for immunisation. Dr Dilley uses an ultrasound when placing the injection to be confident that the anaesthetic is in the correct location. After waiting for 4-5 minutes the local anaesthetic has taken full effect and the penis is numb – the baby can be operated on without further discomfort.

During the operation (which takes approximately 3-4 mins) the foreskin is separated from the head of the penis, the clamp is then placed into position, and the foreskin is removed with a scalpel. A bandage is then applied.

Post-procedure care

• The morning following the circumcision is when the bandage is to be removed. Once this is done Vaseline is to be applied liberally to the penis each nappy change until the wound is fully healed. This usually takes 7-14 days.
• Your baby can be bathed as per your normal routine e.g. daily or every second day. You can use soap-free baby bath products in the bath.
• Your baby may require panadol in the first 24 hours or so (instructions will be given during your consultation).

Things to watch out for:

Every method of circumcision has risks associated with it. The main post-procedure risks of the Surgical Cut Method are:

• Bleeding: Bleeding can occur during the first day or two. During the consultation, you will be given verbal and written information on what to do if this occurs.
• Infection: Infection can occur during the healing process. This happens in less than 1% of patients – if it does occur an oral antibiotic or ointment may be prescribed. During your consultation, Dr Dilley will discuss signs of infection with you.

LONG TERM CONCERNS

Not enough skin removed

The appearance of the penis will change with your son’s body shape. Newborns are often thin and have little fat over the pubic bone. They quickly become good at eating and develop substantial fat deposits, often over the pubic bone, in which case the fat pushes the skin forward along the penis giving it a buried appearance. This buried appearance usually goes when the rest of the puppy fat does, at around four years of age. If the penis becomes buried, ensure the penis is ‘popped out’ with each nappy change for cleaning.

Occasionally the circumcision scar can shrink and trap the head of the penis (pseudophimosis) in the buried position – Dr Dilley can usually relieve this in his office, using a local anaesthetic cream. Often the buried appearance gives parents concern that there may be too much skin present, but this is in fact uncommon – approximately one in 500 boys have additional skin removed by Dr Dilley at a later date at the parent’s request.

If you have concerns regarding the appearance of your son’s penis please make an appointment to see Dr Dilley.

Adhesions

In the few months following the circumcision, the layers of skin are trying to heal themselves and often the remaining inner layer of the foreskin will reattach to the head of the penis. This can be very easily separated with minor discomfort. Equally, the adhesions will undergo spontaneous separation and some stage in the future.

If you have concerns about adhesions please contact the rooms for review by Dr Dilley or one of our nurses.

Meatal Stenosis

A well known complication of newborn circumcision (regardless of the method of circumcision) is urethral meatal stenosis – narrowing of the hole at the end of the penis. This is uncommon and usually noticed when the baby/child has an unusually forceful stream of urine. If meatal stenosis is diagnosed, an operation to widen the hole under a general anaesthetic will be arranged. This happens in around one in 1000 circumcisions.

If you have concerns about your son’s urinary stream please make an appointment to see Dr Dilley.

Make an appointment to see Dr Anthony Dilley at Sydney Children’s Surgery at his clinic in Gymea or Randwick.

Please call 02-9540 4409 to speak with our helpful reception staff, or complete our online contact form.