Techniques of circumcision
Can I be circumcised as an adult
incidence of circumcision
In the USA, 75% of men are circumcised; however, 6% of men are circumcised in the UK. Jews and Muslims are circumcised as a part of their religious obligation. Historically, Christianity has had periods of both pros and cons. In most societies, males are circumcised at birth. Adults are circumcised if they have medical problems or cultural or personal reasons in our London clinics.
Indications of adult circumcision
General Indications
Several medical indications for adult circumcision are phimosis, paraphimosis, and Balanitis, and non-infectious causes include lichen sclerosis (also called BXO - balanitis Xerotica Obliterans), allergic dermatitis, trauma, and Zoon’s balanitis.
Phimosis is a condition in which the foreskin (also called prepuce) is unable to be reduced over the head of the penis (glans penis). This can result in pain with erection and intercourse.
Diabetes is a risk factor for phimosis, recurring balanitis and BXO.
Paraphimosis is a condition in which the foreskin can be retracted over the glans but stuck or tight behind the head of the penis. When there is a partially tight band at the inner skin of the foreskin, and the foreskin does not reduce naturally over the glans, the tight band acts like a constricted ring over the shaft of the penis. A history of recurring paraphimosis may result in a more tight foreskin, leading to swelling of the glans and significant pain. This may require urgent medical treatment.
Balanitis is also a medical indication for circumcision. Balanitis is the infection of the glans penis. Balanitis may occur along with infection of the foreskin. This combination of infections is called balanoposthitis.
The combination of phimosis and diabetes is a recognised risk factor for balanitis. Balanitis can be caused by both infectious and noninfectious causes. In the case of phimosis, fungal infection is also expected along with bacterial infection. Non-infectious causes include allergic dermatitis, trauma, and Zoon’s balanitis.
Sexually transmitted disease (STD) Prevention
Circumcision is a preventative measure against the spread of HIV and AIDS, as shown in many African studies. The inner preputial skin has special cells called Langerhans cells, which contain receptors for HIV. Removing most of the inner preputial foreskin by circumcision may prevent to prevent HIV viruses. Additionally, the inner preputial skin contains a little protective keratin layer relative to the outer foreskin, making it less mechanically resistant to injury, which may be a source of HIV.
Lichen Sclerosis or Balanitis Xerotica Obliterans (BXO)
Lichen sclerosis (LS) can affect both children and adult populations. LS has been known as lichen sclerosis or balanitis xerotica obliterans (BXO). The typical peak ages of presentation of BXO are 8–10 years of age and 30–50 years of age. The clinical presentation can be variable; however, the advanced classic appearance is atrophic white scarring. Purplish scaly scars, red abnormal blood vessels, tears, splits, and ulcerations have also been documented. The foreskin is the largely common site of involvement; however, it can affect the glans, wee hole (meatal opening), and wee tube (urethra). Symptoms can vary according to the different areas of involvement. Please see further information for BXO. Circumcision in men is a medical indication for BXO symptoms.
Circumcision for medical reasons is available in the NHS. However, there is a long waiting list for urological consultation and circumcision in the NHS hospitals.
Surgical Techniques
Although circumcision is done in our London clinic, the best method of circumcision is with the glue with different circumcision styles. We do circumcision with stitches and surgical staplers (ZSR or CircCurer (LangHe) staples suture device). Adult circumcision costs £680 with glue at our London Circumcision Centre. Circumcision cost in the UK depends upon the technique and methods of circumcision. Circumcision is a low-risk surgical procedure, at least in our hands. History of bleeding disorders needs to be excluded, and all medications affecting platelet function (aspirin, clopidogrel, warfarin ) should be stopped 5 days before adult circumcision after a discussion with your doctor.
Anaesthesia
Circumcision can be performed under local or general anaesthesia. Most patients are suitable for local anaesthesia, which involves injections into the skin.
Informed Consent
We provide the patient with all the information about the circumcision, and consent is taken before the procedure in our centre. Circumcision is an irreversible procedure and exposes the glans permanently.
Forceps-guided method, sleeve technique and Glue circumcision are standard techniques used.
The most common method is the glue circumcision technique. It has been reported that the stretched length of the penis is the equivalent length of the erect penis. By having the penis on stretch, we make sure that no excessive shaft skin is excised, which would produce penoscrotal webbing due to underneath skin deficiency and hairy skin from the pubic area pulled to the shaft of the penis due to less shaft skin, especially during erection.
Complications
Risks are bleeding, bruises, haematoma formation, infection, removal of too much or too little skin, lymphoedema, displeasing results that require revision circumcision and a change of sensation during sexual activity.
Sexual Dysfunction
Change in sexual function after circumcision is very controversial. Studies investigating sexual dysfunction have shortcomings of self-reported variables, non-validated questionnaires, small population studies, and the investigation of patients with prior foreskin disease.
Summary
Adult circumcision is a safe surgical procedure with uncommon complications. Adults have circumcision due to tight foreskin (phimosis, paraphimosis), infection (balanitis), and scaring due to lichen sclerosis (BXO). A lot of African studies also reported that circumcision can be preventative in HIV and AIDS transmission and some sexually transmitted infections. Several methods of performing an adult circumcision exist at the London circumcision clinic, but glue circumcision remains our method of choice. Although sensation appears to be different in circumcised adults in the first 6-12 months, studies have not proved if there is any difference in sexual function as compared to uncircumcised men. The benefits of circumcision are well-reported in the literature. Men can be circumcised in our London circumcision Centre.
This is for information about purposes that can not replace professional advice. Please contact Dr Khan or a consultant Urologist for further details.
London Circumcision Centre
NEWBORN AND ADULT CIRCUMCISION FROM EXPERIENCED SURGEONS AND UROLOGISTS
We provide glue, stitch, staplers, revision adult circumcision, frenuloplasty or preputioplasty at London Circumcision Clinic. We also give balanitis xerotica obliterans (phimosis) treatment
Please see feedback from the patent after circumcision and frenuloplasty
“My experience with Dr Khan was very relaxing and quick. I felt comfortable throughout the whole procedure. In my first consultation with Dr Khan, everything was explained to me quite simply, so I knew exactly what to expect and all of my options. My procedure was very quick and very professional, I was given all the information required for post-operation care and also emergency contact just in case. Everything went seamlessly and I would definitely recommend Dr Khan to any prospective patient.”
Adult circumcision with CircCurer (LangHe) staple device (ZSR Circumcision)
First Private Clinic in London, UK, that Offers Circumcision with this Novel CircCurer (LangHe) staples Device
Many patients are asking Dr Khan to circumcise with ZSR or stapler devices. Adult circumcision can be performed by CircCurer (LangHe) or ZSR staples suture device. Dr Khan has simulation training in CircCurer (LangHe) staples suture device.
Dr Khan offers circumcision with this new CircCurer (LangHe) staple device at The London Circumcision Clinic, Leyton, London.
Adult circumcision with CircCurer stapler is a quick procedure. When it was compared with conventional circumcision with stitches, stapler circumcision is associated with shorter surgical time, higher patient satisfaction with penile looks, lower operative pain, less operative blood loss, and lower wound bleeding post-operatively. However, wound healing takes longer than traditional circumcision in adults.
Anaesthesia
A local anaesthetic is used for the circumcision with staplers and injected into the base of the penis and all around the shaft of the penis. This provides safe and effective pain relief during the circumcision. This also minimises post-operative pain for a few hours.
Men's Circumcision Cost with CircCurer in the UK (16-YEAR-OLD AND ABOVE)
Circumcision with stapler Device £780 includes consultation on the same day and one free follow-up visit.
Informed Consent
We provide the patient with all the information about the stapler circumcision ahead of time. Stapler Circumcision is an irreversible procedure and makes the head of the penis exposed permanently. Informed consent is taken before the procedure.
Full or Partial Circumcision
Full circumcision means moderately cutting the inner and outer foreskin to expose the full of head of the penis. Partial circumcision leaves loose skin, which partially covers the glans (head of penis). Partial circumcision may not work in all adults.
Full circumcision might give a false impression of loose/partial circumcision when the penis is in a flaccid state, especially in patients with a buried penis. Partial circumcision is possible, but it has a few complications in the long term. These can be discussed with Dr Khan at the Adult Circumcision Clinic in London, UK
Procedure Technique
The following are methods for adult and boys over 16-year-old for circumcision:
After local anaesthesia, the foreskin was retracted, and assess the suitability.
If there is scarring due to BXO, stapler circumcision is not advisable to perform.
Apply the bell of the instrument inside the foreskin
Secure the right position of the stapling device
Cut the skin and staples applied at the same time
Apply the bandage around the wound at the end of the circumcision
Recovery for Adult Circumcision with staplers
Circumcision with a stapler heals quicker than one with stitches. Swimming and weight lifting should be avoided for 2-3 weeks. Full recovery following circumcision generally requires 4-6 weeks. Over-sensitivity of the glans may take a few months to resolve.
Adult Circumcision Healing Tips
To reduce the effect of night erections, pull on the staplers during the first few days after the adult circumcision, empty your bladder before retiring and a few times during the night. Sleep on your side or back. It may be helpful to draw your knees up a bit into a more foetal position. Wear tight underwear after the circumcision to prevent unnecessary movement. Follow the aftercare advice and keep the wound dry for five days.
Please take vitamin C regularly for ten days to promote healing. If the staplers are completely off, apply vitamin E cream, Mederma gel, or bio-oil to the scar after 15 days. This will improve the scaring. Please contact us at The London Circumcision Centre for further advice.
Medical evidence
Five recent studies involving 2026 men were included in comparing the stapler and conventional circumcisions with stitches. The statistically significant incidence of circumcision with staplers was intra-operative blood loss, operating time, the mean pain score on the operation day, the mean pain scores on post-operation days and wound healing time. The majority of the patients (88.0%) required the removal of residual staples postoperatively after four weeks.
References:
Brazilian Journal of Medical and Biological Research (2015) 48: 577-582
Asian Journal of Andrology (2017) 19, 362–367
Scientific Report (2016) 6, 25514
Risk of Adult Circumcision
The risks of circumcisions are explained to the patients. Risks are failed staple procedure requiring traditional circumcision, bleeding, bruises, haematoma formation, infection, retaining of staplers for more than four weeks, unintentional damage to the glans, removal of too much or too little skin, lymphoedema, aesthetically displeasing results and a change of sensation during sexual activity.
The patient should also be informed that, during the postoperative period, erections can cause pain, bleeding and discomfort. There are slight chances of disruption of the staples or scarring of wounds, which might require a redo or revision circumcision.
Postoperative Care
You might experience discomfort for a few days after the circumcision, but painkillers help to decrease the pain. Passing urine is not usually affected by the circumcision. There will be swelling and bruising of the shaft of the penis for 2 to 3 weeks after the stapler circumcision. This will then subside gradually and should not be a cause for alarm. Bleeding after circumcision can be stopped by applying pressure or a bandage.
A dressing (bandage) is applied around the wound line to prevent the wound from sticking to your underclothes. A bandage with self-adhesive stretch gauze will stay for three days (Cobain). The wound will be at least 2-3 weeks before healing is completed, and you may return to work when you are comfortable enough.
Most people require at least 2-3 days off work. You should gently wash the wound daily after one week if the wound is dry and shower regularly. It would be best to stop going to the gym or lifting heavy weights for 2 weeks. You should avoid any sexual activity for 4-6 weeks after the circumcision to avoid the breakdown of the wound.
Follow up visit
Some of the staplers come off themselves. However, some staples remain over the wound after 3 weeks. All patients require arranging an appointment after 3-4 weeks so that we can remove the residual staples.
PS: This information is for suggestions only. It is not a substitute for professional medical advice. Please call Dr. Khan at +447527314081 for free telephone advice without any obligation.
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