Parent & Patient Information System 06/09/2015 Page34 / 51 After 6 years of age who are capable to communicate and understand the instructions, procedure can be performed with local anesthesia if the child has been psychologically prepared well. In younger children, if circumcision is planned, it should be performed under general anesthesia. This will prevent the psychological impacts and provide a comfortable condition both for the child and the doctor. Several methods have been described for circumcision. One is the surgical excision of the prepucium that sutures are used after the excision to approximate the wound lines. These sutures are absorbable and there is no need to take the sutures. Another method is squezzing the prepucium within a plastic bell-shaped instrument and to wait until the prepucium falls off itself. Some problems might occur after circumcision. It occurs in 1-7% of cases and mostly mild problems. However, in very rare instances, the complications may cause life-long problems. The most frequent problems are bleeding, wound infection, excision of excess or small amount of skin and narrowing of the outer opening of urethra. The extremely rare problems are severe bleeding, amputation of glans and injury to the urethra. The causes for the complications may be listed as following: breakage of the sterility conditions, performance by unspecialized staff, not to make appropriate bleeding control, not to pay attention to glans or urethra and mass circumcisions. It is very infrequent to have a problem after circumcisions those performed in a medical center under appropriate surgical conditions. Phimosis It is the unavailability to retract the skin downwards because of the narrow opening at the most distal part of prepucium. Most of the phimosis cases are physiologic and resolves with time. In physiologic phimosis, appearance of penis is normal. However, if one tries to expose the glans it is not possible to retract the skin or flowering appearance occurs. It is not pathologic and can be seen in 1% of children at 10 years of age. The pathologic phimosis is the narrowing of prepucial opening secondary to chronic scarring tissue as in balanitis xerotica obliterans. The indication for surgery is controversial where in pathologic phimosis surgical circumcision is absolutely indicated.
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