Recipient(s) will receive an email with a link to 'Circumcision using the Plastibell Device' and will have access to the topic for 7 days.
Subject: Circumcision using the Plastibell Device
(Optional message may have a maximum of 1000 characters.)
Two small forceps
A pair of scissors
Prep materials (see Appendix E)
The Plastibell device and ligature
Medical indications, including phimosis, paraphimosis, recurrent balanitis, extensive condyloma acuminata of the prepuce, and squamous cell carcinoma of the prepuce (all rare in neonates)
Routine circumcision is contraindicated with the presence of urethral abnormalities such as hypospadias, epispadias, or megaurethra (i.e., foreskin may be needed for future repair or reconstruction).
Less than 1 cm of penile shaft is visible when pushing down at the base of the penis (i.e., short penile shaft).
Circumcision should not be performed until at least 12 hours after birth to ensure that the infant is stable. Circumcision in infants who are ill or premature should be delayed until they are well or ready for discharge from the hospital.
Bleeding diathesis, myelomeningocele, significant prematurity, or imperforate anus.
When there is a family history of a bleeding disorder, appropriate laboratory studies should be done to identify any bleeding abnormalities in the baby.
PEARL: Some providers prefer a topical anesthetic cream (such as 2.5% prilocaine and 2.5% lidocaine [EMLA]) in place of a dorsal block.
PEARL: Use a pacifier dipped in 25% sucrose to reduce infant discomfort and crying.
PITFALL: Anesthesia failure is often the result of failure to wait the necessary 5 minutes for the block to take effect. Avoid this problem by administering the block before draping the area, and then gently massage the area while waiting the 5 minutes required for maximum anesthetic effect.
PITFALL: Make sure the crush line is far enough above the coronal sulcus that it will be completely removed in the circumcision. If the cut extends too far onto the penile shaft, the proximal portion of the incision (apex) cannot be pulled into the clamp.
PITFALL: If hypospadias or megameatus are present, terminate the procedure because any subsequent repair of these congenital anomalies may require the use of foreskin tissue.
PITFALL: Improper placement of the ligature may increase bleeding complications.
Pain, infection, bleeding.
Phimosis or ring retention (urinary blockage secondary to swelling).
Urethral stenosis, urethrocutaneous fistula, hypospadias and epispadias formation, necrotizing fascitis, penile amputation, and necrosis (all very rare).
If the ring slips below the glans, it can result in venous congestion and necrosis.
Ring migration/incomplete/delayed separation.
Excess foreskin removed.