Circumcision, using clamp or other device with regional dorsal penile or ring block
CPT4 code
Name of the Procedure:
Circumcision, also known as male circumcision, using a clamp or other device with regional dorsal penile or ring block.
Summary
Circumcision is a surgical procedure to remove the foreskin, the retractable fold of skin that covers the glans of the penis. This method uses a clamp or device along with regional anesthesia for pain management. The procedure is common in newborn males but can be performed at any age.
Purpose
Circumcision is performed for various reasons including medical, cultural, or religious. Medically, it may be recommended for conditions like phimosis, paraphimosis, recurrent balanitis, or urinary tract infections. The goals include preventing infections, improving hygiene, and addressing foreskin-related issues.
Indications
- Phimosis (inability to retract foreskin)
- Paraphimosis (foreskin trapped behind the glans)
- Recurrent infections (balanitis or urinary tract infections)
- Personal, cultural, or religious preference
Preparation
- Fasting instructions if general anesthesia is used (usually not required for regional blocks)
- Avoiding certain medications like blood thinners
- Pre-surgical consultation and physical examination
- Informed consent documentation
Procedure Description
- The genital area is cleaned and sterilized.
- Regional dorsal penile or ring block anesthesia is administered for numbing.
- A special clamp (e.g., Gomco, Mogen, or Plastibell) or device is placed on the penis to secure and mark the area for circumcision.
- The foreskin is removed using a scalpel or surgical scissors.
- Hemostasis is ensured, and the device is removed.
- The incision site is closed with sutures or allowed to heal naturally.
Duration
The procedure typically takes about 15-30 minutes.
Setting
Circumcision can be performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Urologist or pediatric surgeon
- Surgical nurse or assistant
- Anesthesiologist or anesthetist (for administering regional block)
Risks and Complications
- Infection
- Bleeding or hematoma
- Inadequate or excessive foreskin removal
- Pain or discomfort during the healing period
- Rare: Injury to the penis or urethra, adverse reaction to anesthesia
Benefits
- Reduced risk of urinary tract infections
- Lowered incidence of foreskin-related issues
- Improved hygiene
- Potential reduction in the risk of certain sexually transmitted infections
Recovery
- Keep the area clean and dry
- Apply prescribed ointments or dressings as directed
- Pain management with oral medications if needed
- Avoid strenuous activities for a few days
- Follow-up appointment to check healing
Alternatives
- Topical steroid creams for phimosis
- Preputioplasty or other foreskin-preserving procedures
- Watchful waiting for milder issues
- Pros: Non-invasive options preserve the foreskin
- Cons: May not resolve all medical issues effectively
Patient Experience
- Minimal discomfort expected due to regional anesthesia
- Mild to moderate pain post-procedure, managed with pain relief medications
- Some swelling and redness around the incision site, usually resolves within a week
- Normal activities can typically be resumed within a few days, but complete healing may take a few weeks