Adult feedback after Glue Circumcision

Dear Dr Khan and team

It is now 3 1/2 months since I attended the thorn hill clinic for my circumcision.

Everything has completely healed and I am very pleased and completely satisfied with the outcome. As is my girlfriend/partner.

When I got home on the day of the operation I took paracetamol as a precaution as the anaesthetic wore off. but that was the only time, I didn’t need it again. I went back to work on the Monday 15th October 2018.

The bandages came off after 3 days, the swelling had almost pushed them off by that point any way. I used the fuicuden cream as instructed but there was no infection so the antibiotic prescription didn’t get used.  Within 2 weeks the swelling had mostly gone down and by week 3 the stitches were gone.

I felt really looked after by you and your colleagues at the clinic, before, during and after the operation.

All in all a good experience (under the circumstance!!) I wish I had booked in with you for a circumcision years ago.

Kind regards

AW

( Email received on 27-01-2019)

Annual audit has improved outcomes of circumcisions

Annual audit has improved outcomes of circumcisions with disposable rings in children in a community clinic under local anaesthesia - Thornhill clinic and Leyton clinic, London

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PURPOSE

To evaluate the early postoperative complications particularly impaction of disposable devices in children’s circumcision procedures under local anaesthesia in a community clinic in this year’s audit versus previous 3 audits. 

MATERIAL AND METHODS

In our current audit cycle, the outcome of circumcisions (n=1222) was prospectively studied over a 1-year period (May 2017 to April 2018) and were compared with the last 3 audit cycles. Circumcision was performed under local anaesthesia, by trained doctors in a community clinic using Circumplast (CC)(n=310) and Plastibell (PC)(n=912).  Early postoperative complications especially ring impaction were compared among the four audits. Follow-up was arranged if required.

RESULTS

The mean age was 4.4±0.3 months (median 1.5). Complication rate in this year’s audit was 5.1%(62/1222). There is no significant difference in overall complications rate in CC(6.8%n=21/310) versus PC(4.5%n=64/979)(p>0.5). Delayed ring separation/impaction is significantly lower in CC (1% n=3/310) versus PC (2.4% n=22/912) (p<0.05) and has significantly improved from the previous three audits. In current year, 202 (16.5%) children were followed and mean duration was 10±2.6 days (median 6).

CONCLUSIONS

The annually conducted audit has shown improved outcomes of circumcisions with disposable rings in children in a community clinic under local anaesthesia over successive years.

Ref: Accepted as presentation and poster in ESPU 30th Meeting, Lyon, France.

The Use of Tissue Glue for Circumcision in Children: Systematic Review and Meta-analysis 2018

 OBJECTIVE

To evaluate the efficacy of tissue glue in pediatric (children) circumcision.

 MATERIALS AND METHODS

A systematic review and meta-analysis of the English literature (1997-2017) was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement on children who underwent circumcision with tissue glue. Meta-analysis was conducted using RevMan 5.3, Comprehensive Meta-Analysis 2, and MedCalc 18. P values <.05 were considered significant.

 RESULTS

The search returned 15 studies for a total of 4567 circumcisions, of which 3045 (66%) were performed with tissue glue. The systematic review indicated that overall complication rates were 4.3% (tissue glue) and 5.9% (sutures). The use of tissue glue was associated with reduced postoperative pain, better cosmetic results, and reduced cost. Meta-analysis showed that there was no difference between the incidence of total postoperative complications (relative risk [RR] 0.86 [95% confidence interval {CI}: 0.62-1.19], P = .36) and wound infection and dehiscence between the 2 groups (RR 0.95 [95% CI: 0.59-1.56], P = .85). Postoperative bleeding and hematoma formation were reduced with the use of tissue glue (RR 0.55 [95% CI: 0.32-0.95], P = .03). Tissue glue also significantly shorten the operative time (mean difference −0.22 [95% CI: −0.39 to −0.05], P = .01).

 CONCLUSION

The incidence of postoperative bleeding and hematoma formation in pediatric circumcision is reduced with the use of tissue glue. Tissue glue has reduced operative time; furthermore, it might be associated with reduced postoperative pain, less overall cost, and superior cosmetic results.

Ref: UROLOGY 115: 21–28, 2018. © 2018 Elsevier Inc.

CQC published the case study- London Circumcision Clinic fulfils 95% standards

Case study – good practice for Newborn or Baby circumcision

This case study is taken from a GP practice that has conducted traditional circumcision for 28 years. ( published CQC website)

In this practice, parents receive written information and advice in advance of the procedure. This includes a consent form and information about aftercare. The practice requires both parents to give consent to the procedure.

Parents are advised not to feed the infant for two hours before the procedure. This ensures that the baby feeds immediately afterwards to provide comfort.

The doctor assesses the level and type of local anaesthesia appropriate for each infant, taking account of their age and weight and the requirements of the procedure. Pain relief is proportionate and appropriate for the individual needs of the infant.

If the doctor concludes that the procedure cannot be safely conducted in his GP practice, he advises parents of this and suggests alternative options (for example, referral to hospital care).

During the procedure, the infant is held comfortably still. Another person is always present to assist and respond to the infant’s needs if they are in any distress.

The family is advised to remain at the practice for at least an hour after the procedure and once the doctors is certain that the baby is not bleeding.

The doctor is available for aftercare and the arrangements for follow up are clear.

Written instructions for parents include a request to text or ring the doctor after their first check. The parents are advised to contact the doctor at any time by text or phone if they have any concerns. If this happens, the doctor will visit the baby at home or see him at the surgery, as is most appropriate.

The doctor encourages good practice among other providers by offering training in the procedure.

Ref: 

Advice for inspectors

Circumcision of male children

January 2016 Care Quality Commission