Royal college of Surgeons England guideline for children circumcision

Criteria to be fulfilled in performing circumcision (Royal College of Surgeons of England, 2000)

• The operation should be performed by, or under the supervision of, doctors trained in children's surgery

• The child must receive adequate pain control during and after the operation

• The parents and, where competent, the child, must be made fully aware of the implications of this operation as it is a non-reversible procedure

• This operation must be undertaken in an operating theatre or an environment capable of fulfilling guidelines for any other surgical operation

• The person responsible for the operation must be available and capable of dealing with any complications which may arise

• There should be close links with the patient's GP and community services for continuing care after the operation

Accurate records of all procedures and audit of results are essential. 

According to the Royal College of Surgeons of England guidance, the one absolute indication for circumcision is pathological phimosis. This is scarring of the opening of the foreskin, making it non-retractable. Other indications also involve the removal of an abnormal foreskin, including penile malignancy, traumatic foreskin injury, and severe recurrent attacks of balanoposthitis

Royal College of Surgeons of England. Male Circumcision: guidance for Healthcare Practitioners. RCSENG - communications; 2000.

Early infant circumcision? Risks and benefits.

Professor Emeritus Brian J. Morris has publised an article in the medical literatutre.

"Evidence-based policy statements by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and “ballooning” during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible infections in both sexes, genital ulcers, and penile, prostate and cervical cancer. Our risk-benefit analysis showed that benefits exceeded procedural risks, which are predominantly minor, by up to 200 to 1. We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical con- dition over their lifetime. Wide-ranging evidence from surveys, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function, sensitivity or pleasure. United States studies showed that early infant MC is cost saving. The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews."

Reference: Early infant male circumcision: Systematic review, risk benefit analysis, and progress in policy 2017

ADEQUATE PERI-OPERATIVE MANAGEMENT DECREASES COSMETIC COMPLICATIONS AFTER CIRCUMCISION WITH DISPOSABLE RING IN CHILDREN

Dr. Khan will present our results in his poster presentation at Barcelona, Spain on ESPU Meeting on Friday 21, April 2017. 

"We reviewed our experience in treating children with cosmetic complications following non-therapeutic male circumcision (NMC) with Plastibell and Circumplast devices at a community clinics ( Thornhill Clinic, Luton, Leyton Clinic, Leyton and Croydon London Clinic). This study highlights the factors leading to these complications and clinical management to improve the cosmetic appearance

A retrospective review of 3360 children who underwent Circumplast (CC) and Plastibell circumcision (PC) under local anaesthesia at the community clinics from May 2014 to October 2016. "

Dr. Khan - a member of the Independent Doctors Federation (IDF)

Dr. Khan's  application for membership has now been approved by IDF Executive Committee on 12 April 2017.

The Independent Doctors Federation (IDF) is most innovative, forward thinking and active independent medical practitioner organisation in Great Britain.  We are recognised as the nationwide voice of independent doctors in all matters relating to private medicine, their education and revalidation.