Circumcision (Male; Newborn and Infant)

Description

Male circumcision is the removal of some or the entire foreskin of the phallus.

Indications

Parental or religious preference (not a medically indicated procedure). Circumcision of newborns should be performed only on healthy and stable infants.

Contraindications

Age greater than 6–8 weeks (relative), age less than 12 hours, ambiguous genitalia, hypospadias, illness, less than 1 hour postprandial, possibility of blood dyscrasia, prematurity, undescended testicles (relative). A family history of intolerance or allergy to local anesthetics should prompt reconsideration.

Required Equipment

• Infant restraint board (“papoose” board)

• Sterile gloves

• Sterile drape (one with a small fenestration or multiple drapes)

• Skin preparation materials (eg, povidone–iodine and 70% isopropyl alcohol)

• Sterile gauze pads (2- × 2-inch or 4- × 4-inch)

• Three hemostats (small tips, two curved, one straight)

• Small scissors or scalpel (#10 or #11 blade)

• Flexible blunt probe

• Gomco clamp (1.1–1.45 cm) or Plastibell (1.3–1.6 cm) or Mogen clamp (for clamp methods)

• Sterile safety pin, clip, or skin staple (optional)

• Viscous lidocaine (2%–5%) or 1% lidocaine without epinephrine, 1-mL syringe, 27-gauge needle for dorsal penile nerve or ring block. EMLA cream may also be used but is associated with an 8%–14% incidence of erythema, swelling, and, rarely, blistering.

• Petrolatum (Vaseline) gauze

• Monsel solution (ferric subsulfate)

• Small suture (3-0 or 4-0 absorbable) and needle holder (available)

Electrosurgical devices should never be used in conjunction with any of the clamp-based procedures.

A bulb syringe should be kept near during circumcision as a protection against aspiration should the newborn regurgitate.