Global Health Asia-Pacific Special Issue | Page 33


Circumcision - Cutting to the chase

By : AdvancedUrology ( Singapore )
How is circumcision performed in hospitals today ? Circumcision is most commonly performed using either the dorsal slit or the sleeve techniques . The excess foreskin is divided down to the base of the glans penis and removed , leaving a cuff of healthy tissue around the glans penis . Bleeding points are controlled ( usually with cautery ), and the edges of the two layers are stitched together using absorbable sutures . In certain centres , a CO2 laser is used to remove the excess foreskin .
This is reported to result in less bleeding during the surgery itself , shortening the duration of the surgical procedure . Depending on the patient ’ s ( or parents ’) preference , the surgery may be performed under local anaesthesia , penile nerve blocks or general anaesthesia . In most uncomplicated cases , it should not take more than 30 minutes to complete .
It is perhaps the most common surgical procedure performed worldwide , with about one-third of the world ’ s male population being circumcised .

Circumcision refers to the surgical removal of the foreskin at its attachment to the base of the glans of the penis . It is perhaps the most common surgical procedure performed worldwide , with about one-third of the world ’ s male population being circumcised .

Circumcision is routinely performed in many countries at birth for religious or personal reasons . It is also performed in adults for various medical conditions such as :
• Phimosis , where the foreskin of the penis cannot be retracted without causing pain or bleeding
• Paraphimosis , where the retracted foreskin cannot be replaced and becomes swollen and painful
• Severe balanoposthitis , where the glans penis and the overlying foreskin are badly infected and swollen
• Tumours or cysts arising from the penile foreskin
• Recurrent urinary tract infections
Are there any health benefits to male circumcision ? In their policy statement on male circumcision , the American Academy of Paediatrics identified several benefits , such as the prevention of urinary tract infections , penile cancer , and transmission of sexually transmitted diseases ( STDs ). 2 In HIV-endemic countries in Africa , the incidence of HIV in sexually active heterosexual circumcised males is reduced by up to 66 %, whilst the risk of acquiring herpes Type 2 virus is reduced by 28 %.
However , circumcision should not be performed when infant males have anatomical abnormalities of the urethral meatus ( hypospadias or epispadias ), the curvature of the penile head ( chordee ), or ambiguous genitalia , as the foreskin will be required for definitive reconstructive surgery later on .
How long will it take to recover ? Patients are usually discharged home the same day of surgery with a course of antibiotics and painkillers . Pain over the wound site usually resolves after two to three days in uncomplicated cases , and adult patients can expect to return to work after a week . The use of absorbable sutures means that these will usually drop off once the wound has healed .
Advanced Urology is the largest group of urology specialists in private practice in Singapore . We are conveniently located in the 6 major private hospitals across Singapore . Founded in 2018 , our team comprises of 6 highly experienced urologists who are all respected in their individual subspecialities . For any inquiries , do reach out to us at enquiry @ urology . com . sg or call + 65 8866 1838 .
GlobalHealthAndTravel . com ISSUE 6 | 2022