Name of the Procedure:

Slitting of prepuce, dorsal or lateral (separate procedure); newborn

Summary

This procedure involves creating a slit in the foreskin of a newborn, either on the dorsal (top) side or lateral (side), to alleviate certain medical conditions.

Purpose

The primary aim is to address issues such as phimosis (tight foreskin that cannot be retracted) or to facilitate urinary flow problems. The desired outcome is to relieve discomfort, prevent infections, and improve foreskin retraction.

Indications

• Phimosis causing obstruction or infection
• Ballooning of the foreskin during urination
• Recurrent urinary tract infections
• Balanitis (inflammation of the foreskin)

Preparation

• No special preparation is typically needed for a newborn.
• Parents may be asked to ensure the baby's genital area is clean.
• A thorough physical examination by a pediatrician or pediatric urologist is conducted.

Procedure Description

1. The medical professional will clean the genital area with an antiseptic solution.
2. Local anesthesia is applied to numb the area, ensuring the newborn feels no pain.
3. A small, precise incision is made on the prepuce (foreskin), either on the dorsal (top) or lateral (side) aspect.
4. The foreskin is gently parted to improve retraction and alleviate the obstruction or issue.
5. The area is cleaned again, and a small dressing may be applied.

Tools: Small surgical scissors or scalpel, antiseptic solution, sterile gloves, and dressing materials. Anesthesia: Local anesthesia specific for newborns.

Duration

The procedure typically takes about 10-15 minutes.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Pediatrician or pediatric urologist
• Nurse or surgical assistant
• Anesthesiologist or specialist administering local anesthesia

Risks and Complications

Common risks:

• Minor bleeding
• Mild pain or discomfort
• Possible infection

Rare complications:

• Excessive bleeding
• Scarring
• Incomplete resolution requiring further intervention

Benefits

• Relief from symptoms associated with phimosis or urinary obstruction
• Reduced risk of infection and inflammation
• Improved urinary flow and foreskin retraction

Benefits are usually realized immediately or shortly after healing.

Recovery

• Parents are advised to keep the area clean and dry.
• Application of a prescribed ointment to the incision site.
• Monitor for any signs of infection (redness, swelling, discharge).
• Follow-up appointment to ensure proper healing.

Recovery typically takes a few days to a week.

Alternatives

• Observation and waiting, particularly if the child has no symptoms.
• Full circumcision if recurrent issues arise.
• Topical steroid creams to loosen the foreskin.

Pros and cons of alternatives:

• Observation: Least invasive but might not resolve symptoms.
• Circumcision: More definitive but involves a longer recovery.
• Topical creams: Non-surgical but requires consistent application and might not be effective.

Patient Experience

During the procedure, the baby will be under local anesthesia, ensuring minimal discomfort. Post-procedure, there may be slight discomfort or irritation, manageable with pediatric pain medications if needed. Parents will be instructed on how to care for the incision site to ensure a smooth recovery.