Dorsal slit of foreskin- alternative treatment

Information about dorsal slit of foreskin from The British Association of Urological Surgeons (BAUS)- recently published June 2017

Alternative treatment for tight foreskin

Key Points

• This is a short-stay procedure to relieve a tight foreskin

• It is sometimes used in emergency situations when the foreskin is swollen or stuck in a retracted position (paraphimosis)

• It can be used as an alternative to circumcision in patients who are unfit or are unwilling to be circumcised

• We make a single incision along the length of your foreskin to expose the head of your penis without removing any tissue

• The cosmetic appearance after the procedure is not as good as it is after circumcision

Circumcision, to remove the foreskin completely, may be needed at a later stage

plesse see following full document online.  

Dorsal slit foreskin. June 2017 

GMC guideline about chaperone policy for intimate examinations - Good Medical Practice 2013

The GMC guidance in Good Medical Practice 2013 indicates: 

Chaperon policy

"1. When you carry out an intimate examination, you should offer the patient the option of having an impartial observer (a chaperone) present wherever possible. This applies whether or not you are the same gender as the patient.

2. A chaperone should usually be a health professional and you must be satised that the chaperone will:

a. Be sensitive and respect the patient’s dignity and con dentiality

b. Reassure the patient if they show signs of distress or discomfort

c. Be familiar with the procedures involved in a routine intimate examination

d. Stay for the whole examination and be able to see what the doctor is doing, if practical

e. Be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.

3.  A relative or friend of the patient is not an impartial observer and so would not usually be a suitable chaperone, but you should comply with a reasonable request to have such a person present as well as a chaperone.

4. If either you or the patient does not want the examination to go ahead without a chaperone present, or if either of you is uncomfortable with the choice of chaperone, you may offer to delay the examination to a later date when a suitable chaperone will be available, as long as the delay would not adversely affect the patient’s health.

5. If you don’t want to go ahead without a chaperone present but the patient has said no to having one, you must explain clearly why you want a chaperone present. Ultimately the patient’s clinical needs must take precedence. You may wish to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as a delay would not adversely affect the patient’s health.

6. You should record any discussion about chaperones and the outcome in the patient’s medical record. If a chaperone is present, you should record that fact and make a note of their identity. If the patient does not want a chaperone, you should record that the offer was made and declined".

Our clinic is followed above guidelines during all intimate examination of the patients. 

GMC good medical practice 2013

Low incidence of bleeding in ritual or religious circumcision under one month old child

This was reported in recent study published by Mano R, et al. Urology. 2017.

"Abstract

OBJECTIVE: To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment.

MATERIALS AND METHODS: The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated.

RESULTS: An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants.

CONCLUSION: Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged."

Copyright © 2017 Elsevier Inc. All rights reserved.

PMID

28389263

Frenuloplasty - lengthening of penile frenulum: Information about frenuloplasty from The British Association of Urological Surgeons (BAUS)

Please read this document for the Frenuloplasty- lengthening of penile frenulum

 publiashed by BAUS

Resource:  http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Frenuloplasty.pdf