What is the Best Age of Newborn Circumcision

The best age for newborn circumcision is 1-6 weeks when a newborn is born full term. We discussed our audit about the outcome of infant circumcision at our Circumcision clinic. 

Cultural, religious, and personal beliefs that have influenced non-therapeutic male infant circumcision (IMC). Without national medical guidelines, parents and doctors often make decisions regarding the timing of this procedure based on various factors. At the Circumcision Centre, we have undertaken a review to shed light on the optimal age for male children's circumcision. This blog will examine the audit conducted at our circumcision clinic, focusing on using Plastibell and Circumplast devices. We will discuss the findings suggesting infant male circumcision (IMC) is most successful when performed before a child reaches six months. The ideal age of newborn circumcision is  1-6 weeks. 

The Study

Over one year, from May 2014 to April 2015, the London Circumcision Centre meticulously reviewed 1,387 infant male circumcisions. These circumcisions were performed under local anaesthesia using the Plastibell and Circumplast devices. Data was collected prospectively, allowing for a careful examination of early postoperative complications in two age groups: children under six months of age (Group A) and those aged 6 to 110 months (Group B). Follow-up consultations were scheduled to monitor the healing process and address any concerns.

Results

The study revealed some findings that have significant implications for the best age of children's circumcision:

1. Mean Age: The average age for circumcisions in Group A was 1.6 months (with a median of 1.1 months), whereas in Group B, it was 38 months (with a median of 29 months).

2. Complication Rates:  Perhaps the most striking discovery was the substantial difference in complication rates between the two age groups. In Group A, where circumcisions were performed on children under six months, complications occurred in only 7.1% of cases (74 out of 1,038). In contrast, Group B, comprising older children, experienced a significantly higher complication rate of 26.7% (93 out of 349). The statistical analysis revealed that this difference was highly significant (p<0.5).

3. Ring Impaction/Migration: The complication associated with IMC, ring impaction or migration, was much less common in Group A, with only 2.6% of cases experiencing this issue. In contrast, Group B had a significantly higher incidence of 23% (27 out of 81) encountering ring impaction/migration (p<0.5). Circumcision with Circumplast device has no migration in IMC.

4. Postoperative Antibiotics: The use of antibiotics after the procedure was somewhat lower in Group A (4.3%) compared to Group B (6.9%). However, statistical analysis did not reveal a significant difference in this aspect.

5. Follow-Up: Group A required significantly less follow-up (25%) than Group B (52%), indicating that younger patients tended to have a smoother postoperative course. The mean follow-up period was also notably longer for Group A at 24 days compared to 14 days for Group B.

Conclusion

This audit at the Circumcision Centre concluded the best age for non-therapeutic male children circumcision. The key takeaway from this research is clear: the incidence of complications associated with IMC is significantly lower when performed on children under six months of age. 

These findings provide valuable guidance for parents and doctors considering IMC. Cultural, religious, and personal beliefs will always play a role in the decision-making of GP clinics using Plastibell and Circumplast devices. Circumplast devices have fewer complications than Plastibell devices, especially migrations.

P.S. This study was presented to European Society of Paediatric Urologists at the 27th ESPU Congress - Harrogate, England, UK

We have made a few changes in our practice after this study

1. We use Circumplast devices rather than Plastibell in infant male Circumcision

2. We stop using the “ring method” in children older than five years of age

3. The best age for newborn circumcision is between 1 to 6 weeks under local anaesthesia

Baby and Newborn Circumcision

Newborn baby boys Circumcision by Ring Method: Circumplast or Plastibell rings

The best or ideal age of circumcision is 1- 8 weeks old

Circumcision at London Clinic by a Specialist Paediatric Surgeon/Urologist, 30 Years Experience, Painless Circumcisions, 24/7 Aftercare Support by doctor

Book now

Baby Circumcision Guideline before the operation at London Circumcision Centre

Diabetes and Tight Foreskin

A comprehensive study conducted in the United Kingdom focused on a group of 100 men ranging in age from 17 to 82 years, with an average age of 38 years. The study aimed to investigate the prevalence and characteristics of phimosis, a condition characterized by the tight foreskin, in this population.

The researchers found that among the participants, 31% had a lifelong history of phimosis, meaning they had experienced this condition since birth or early childhood, while the remaining 69% had acquired phimosis, meaning it developed later in life. It is worth noting that the prevalence of acquired phimosis was significantly higher than that of lifelong phimosis.

Additionally, the study revealed that among the men with acquired phimosis, 32% had a medical history of diabetes. This finding indicated a notable association between acquired phimosis and diabetes. In fact, the data showed that men with a history of diabetes were 6.7 times more likely to develop phimosis compared to those without diabetes.

Moreover, the researchers observed that phimosis could potentially serve as a warning sign for diabetes. Surprisingly, among the men who had acquired phimosis but had no previous history of glucose metabolism disorders or diabetes, 12% were found to have diabetes (8%) or impaired fasting glycemia (4%). This prevalence of diabetes was higher than the national average in the UK, which stood at 3.6% during the study period. These findings suggest that the presence of phimosis in some individuals may indicate an increased likelihood of diabetes or related metabolic disorders.

It is important to note that balanitis, a condition characterized by inflammation of the glans penis, is commonly associated with diabetes. The recurrent infections and scarring resulting from balanitis are likely contributing factors to the development of phimosis in individuals with diabetes.

In summary, this UK-based study shed light on the prevalence and implications of phimosis in a diverse group of men. The findings indicate that acquired phimosis is more common than lifelong phimosis and that there is a significant association between phimosis and diabetes. Furthermore, the study suggests that phimosis could potentially serve as an indicator of diabetes, as a higher proportion of men with phimosis were found to have diabetes or impaired fasting glycemia compared to the general population. The study also emphasized the relationship between balanitis and phimosis in individuals with diabetes, highlighting the role of recurrent infections and scarring in the development of this condition.

We provide is comprehensive treatment of tight foreskin (Phimosis) and also we treat with tight foreskin with diabetics. In some patients , BXO or lichen sclerosis is also present which required treatment in the form of topical steroids, antibiotics, anti fugal and circumcision in most of the advanced BXO.

Reference:

SJ Bromage, A Crump, I Pearce

Phimosis as a presenting feature of diabetes

BJU Int, 101 (2007), pp. 338-340

Jet injection without needle local anaesthesia in adults’ and children's circumcision - recent study

Circumcision: Exploring Different Approaches for Adults and Boys for local anaesthesia

Circumcision is a practice that is often carried out for religious, traditional, and medical reasons. In our country, most men undergo circumcision, and most of these procedures are performed using local anaesthesia. Since circumcision is primarily performed for religious purposes, families typically want their children to know the procedure. Therefore, the preschool period is often chosen as the ideal age for circumcision in Turkey. However, circumcisions performed during this stage, when a child discovers their sexual identity, can negatively affect psychosexual development.

Additionally, using a needle for local anaesthetic injections can significantly increase anxiety in children. Despite the use of topical anaesthetic creams to reduce stress, needle phobia remains unresolved. Research indicates that 63% of children in the USA are afraid of needles.

Needle phobia is a concern for children and adult patients in circumcision procedures. To address this issue, some studies have explored using needle-free jet injectors. For example, Peng et al. found that a no-needle jet injector technique was safe, effective, and well-tolerated for adult circumcision. Similarly, jet injectors have been used in urology practice, such as vasectomy procedures, with high patient acceptance rates. However, the literature has conflicting opinions regarding the pain associated with jet injector injections compared to conventional needle injections.

In urology, jet injectors have been used for intracavernosal alprostadil injections in patients with erectile dysfunction. However, studies have shown that the procedure is more painful and less effective than the conventional needle method, leading patients to prefer the latter. This study aimed to evaluate the effectiveness of jet injector anaesthesia in children who reject needle injections during circumcisions performed under local anaesthesia. However, we observed that local anaesthetic injection with a jet injector did not provide sufficient pain relief for a comfortable circumcision.

The epidermis, the outer layer of the skin, varies in thickness across different parts of the body. For instance, the thickness of the epidermis on the eyelid is 0.04 mm, while it can reach up to 1.6 mm on the palm. The dorsal part of the penis has a thicker epidermis than the ventral surface, which can affect the penetration of the anaesthetic agent when using jet injectors. Injections on the ventral surface may pose a risk of urethral injuries due to the thinner epidermis in that area.

Several parameters are crucial for jet injectors, including thrust pressure, contact pressure, drug volume per shot, nozzle opening, and the distance from the nozzle tip to the skin surface. For small operations, the recommended anaesthetic dose delivered with a jet injector is 0.07-0.1 ml per spurt, with a nozzle diameter of 0.1 mm and an application pressure of 130-160 psi. However, studies have shown that increasing the nozzle diameter may result in deeper penetration and increased pain. Using newer-generation jet injectors with lower pressure has been demonstrated to achieve the same penetration depth with less pain.

In this recent study, consistent with findings in the literature, injection with a jet injector without a needle was better tolerated than the conventional needle method. However, the time for local numbness was long, and the amount of anaesthetic agent used was lower in the jet injector group. However, the FLACC scores (a pain assessment tool) measured during circumcision were higher in the jet injector group, and additional anaesthetic medication was needed for circumcision in children and adults. 

We provide a service for needless anaesthesia with some additional fees for needle-phobic adults and children. 

Please get in touch with us for further details. 

“We provide without needle local anaesthesia in our clinic ”

— https://doi.org/10.1080/08941939.2020.1817635